Provider Demographics
NPI:1215445291
Name:VALLEY ADVANTAGE MEDICAL GROUP INC
Entity type:Organization
Organization Name:VALLEY ADVANTAGE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAM
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:408-258-5083
Mailing Address - Street 1:4945 PALEMETTO DUNES CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2131
Mailing Address - Country:US
Mailing Address - Phone:408-258-5083
Mailing Address - Fax:408-258-4347
Practice Address - Street 1:2365 QUIMBY ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1337
Practice Address - Country:US
Practice Address - Phone:408-550-2750
Practice Address - Fax:408-550-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X
CA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty