Healthcare Provider Details

I. General information

NPI: 1184605859
Provider Name (Legal Business Name): LOUIS PAK-SHUN VU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 W THUNDERBIRD RD SUITE 110
GLENDALE AZ
85306-4706
US

IV. Provider business mailing address

5310 W THUNDERBIRD RD SUITE 110
GLENDALE AZ
85306-4706
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-4510
  • Fax: 602-865-6100
Mailing address:
  • Phone: 602-865-4510
  • Fax: 602-865-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25183
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number25183
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: