Provider Demographics
NPI:1972528016
Name:TO, AN NGOC (MD)
Entity type:Individual
Prefix:DR
First Name:AN
Middle Name:NGOC
Last Name:TO
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 1:87 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5423
Mailing Address - Country:US
Mailing Address - Phone:408-279-1180
Mailing Address - Fax:408-279-6745
Practice Address - Street 1:87 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5423
Practice Address - Country:US
Practice Address - Phone:408-279-1180
Practice Address - Fax:408-279-6745
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4805916Medicaid
CAA28072Medicare UPIN