Basic Information
| Provider Information | |||||||||
| NPI: | 1750505145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANUDEN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HENRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2125 OAK GROVE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252967150 | ||||||||
| FaxNumber: | 9252967171 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 OAK GROVE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252967150 | ||||||||
| FaxNumber: | 9252967171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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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 | 2085R0202X | A91415 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.