Healthcare Provider Details

I. General information

NPI: 1437779238
Provider Name (Legal Business Name): CATHERINE KHANH-AN VU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ARIZONA ST
BISBEE AZ
85603-1804
US

IV. Provider business mailing address

1201 COLOMBO AVE APT 3104
SIERRA VISTA AZ
85635-5305
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-3309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number010276
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: