Provider Demographics
NPI:1174705107
Name:DO, ALICE NGOC (DO)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:NGOC
Last Name:DO
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Gender:F
Credentials:DO
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Mailing Address - Street 1:1 SHRADER STREET
Mailing Address - Street 2:SUITE # 640
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117
Mailing Address - Country:US
Mailing Address - Phone:415-422-0000
Mailing Address - Fax:415-424-4140
Practice Address - Street 1:1 SHRADER STREET
Practice Address - Street 2:SUITE #640
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:415-422-0000
Practice Address - Fax:415-424-4140
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2020-10-06
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Provider Licenses
StateLicense IDTaxonomies
MI5101016735207N00000X
CA20A9018207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFO220AMedicare PIN