Provider Demographics
NPI:1194705186
Name:VAUGHAN, DAVID ALOYSIUS (MD FACC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALOYSIUS
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SULLIVAN AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2222
Mailing Address - Country:US
Mailing Address - Phone:650-992-0463
Mailing Address - Fax:650-992-8912
Practice Address - Street 1:1800 SULLIVAN AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2222
Practice Address - Country:US
Practice Address - Phone:650-992-0463
Practice Address - Fax:650-992-8912
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51966207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088110Medicaid
CAZZZ60314ZOtherBLUE SHIELD GROUP #
CA060054511Medicare ID - Type UnspecifiedRAILROAD MEDICARE
CAGR0088110Medicaid
A52134Medicare UPIN
CA00G519660Medicare PIN