Provider Demographics
NPI:1417335134
Name:LA, VAN TIEU (DO)
Entity type:Individual
Prefix:
First Name:VAN
Middle Name:TIEU
Last Name:LA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S. 1ST ST. #101
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:951-486-4397
Mailing Address - Fax:
Practice Address - Street 1:220 S. 1ST ST. #101
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-281-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2022-10-14
Deactivation Date:2022-10-04
Deactivation Code:
Reactivation Date:2022-10-13
Provider Licenses
StateLicense IDTaxonomies
CA20A15659207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease