Healthcare Provider Details

I. General information

NPI: 1932427341
Provider Name (Legal Business Name): TAN N VU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E BETHANY HOME RD STE B112
PHOENIX AZ
85014
US

IV. Provider business mailing address

727 E BETHANY HOME RD STE B112
PHOENIX AZ
85014-2151
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-2400
  • Fax: 602-603-1302
Mailing address:
  • Phone: 602-279-2400
  • Fax: 602-603-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55675
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: