Healthcare Provider Details

I. General information

NPI: 1477755635
Provider Name (Legal Business Name): KIEN QUANG VUU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/06/2024
Certification Date: 07/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S BRAND BLVD STE 188
GLENDALE CA
91204-2641
US

IV. Provider business mailing address

1200 S BRAND BLVD STE 188
GLENDALE CA
91204-2641
US

V. Phone/Fax

Practice location:
  • Phone: 626-673-5436
  • Fax:
Mailing address:
  • Phone: 626-673-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA104740
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA104740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: