Provider Demographics
NPI:1720334279
Name:LUYEN V. TA, M.D., INC/TUONG-VI TA, M.D.
Entity type:Organization
Organization Name:LUYEN V. TA, M.D., INC/TUONG-VI TA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TUONG-VI
Authorized Official - Middle Name:
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:510-836-1095
Mailing Address - Street 1:341 9TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607
Mailing Address - Country:US
Mailing Address - Phone:510-836-1095
Mailing Address - Fax:510-836-1096
Practice Address - Street 1:341 9TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:510-836-1095
Practice Address - Fax:510-836-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA373562084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty