Basic Information
| Provider Information | |||||||||
| NPI: | 1710017074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANH | ||||||||
| FirstName: | CO | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39350 CIVIC CENTER DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945382331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107973933 | ||||||||
| FaxNumber: | 5107975184 | ||||||||
| Practice Location | |||||||||
| Address1: | 39350 CIVIC CENTER DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945382331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107973933 | ||||||||
| FaxNumber: | 5105852396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 05/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A95318 | CA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.