Organization
MB PHOTOMEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUNG LE (CHIEF FINANCIAL OFFICER)
(408) 429-8181
Entity
Organization
Contact information
Practice address
3185 S BASCOM AVE, CAMPBELL, CA 95008-6728
(408) 429-8181
Mailing address
3185 S BASCOM AVE, CAMPBELL, CA 95008-6728
(408) 429-8181
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QV0200X
VA Clinic/Center
—
—
Other
Enumeration date
10/20/2023
Last updated
11/04/2023
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