Provider Demographics
NPI:1649550872
Name:AU, VIVIEN (DO)
Entity type:Individual
Prefix:DR
First Name:VIVIEN
Middle Name:
Last Name:AU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 E COLORADO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3747
Mailing Address - Country:US
Mailing Address - Phone:626-793-3475
Mailing Address - Fax:
Practice Address - Street 1:2619 E COLORADO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3747
Practice Address - Country:US
Practice Address - Phone:626-793-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014234207W00000X
PAOS017656207W00000X
CA20A14980207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology