MEDICARE: DR. MINH TRANG NGOC VU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1205924362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINH TRANG NGOC VU DDS

Provider Business Mailing Address
First Line	:	95 HACKNEY LN
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46385-6068
Country	:	US
Telephone Number	:	219-477-2782
Fax Number	:	773-374-9422

Provider Business Practice Location Address
First Line	:	7615 S JEFFERY BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-4015
Country	:	US
Telephone Number	:	773-374-9924
Fax Number	:	773-374-9422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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