Healthcare Provider Details

I. General information

NPI: 1285012096
Provider Name (Legal Business Name): KIMLIEN VU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16333 HARBOR BLVD
FOUNTAIN VALLEY CA
92708-1311
US

IV. Provider business mailing address

16333 HARBOR BLVD
FOUNTAIN VALLEY CA
92708-1311
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-1300
  • Fax: 714-433-3100
Mailing address:
  • Phone: 714-549-1300
  • Fax: 714-433-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95000051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: