Provider Demographics
NPI:1306941430
Name:VAN AKEN, TERRELL B (MD)
Entity type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:B
Last Name:VAN AKEN
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 1:167 BOUNTY LN
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3120
Mailing Address - Country:US
Mailing Address - Phone:707-646-3577
Mailing Address - Fax:707-646-3575
Practice Address - Street 1:167 BOUNTY LN
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3120
Practice Address - Country:US
Practice Address - Phone:707-646-3577
Practice Address - Fax:707-646-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E90684Medicare UPIN
CA00G578370Medicare ID - Type UnspecifiedCALIFORNIA MEDICAL LICENS