Provider Demographics
NPI:1215924451
Name:VO, NHAT CONG (MD)
Entity type:Individual
Prefix:DR
First Name:NHAT
Middle Name:CONG
Last Name:VO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 PATRIOT DR
Mailing Address - Street 2:STE102
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3407
Mailing Address - Country:US
Mailing Address - Phone:805-532-2032
Mailing Address - Fax:805-532-2844
Practice Address - Street 1:865 PATRIOT DR
Practice Address - Street 2:STE 102
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3407
Practice Address - Country:US
Practice Address - Phone:805-532-2032
Practice Address - Fax:805-532-2844
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60568207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A605680Medicaid
CAWA60568CMedicare ID - Type Unspecified
CAG88245Medicare UPIN