Healthcare Provider Details

I. General information

NPI: 1689463358
Provider Name (Legal Business Name): VU NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 FRONTAGE RD
BULLHEAD CITY AZ
86442-8154
US

IV. Provider business mailing address

2273 SUNRISE TRL
BULLHEAD CITY AZ
86442-4410
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-0220
  • Fax:
Mailing address:
  • Phone: 408-833-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012533
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: