Healthcare Provider Details

I. General information

NPI: 1700611290
Provider Name (Legal Business Name): CHRISTINE VU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE TAM VU

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER STE 240
GLENDALE CA
91206-4033
US

IV. Provider business mailing address

1505 WILSON TER STE 240
GLENDALE CA
91206-4033
US

V. Phone/Fax

Practice location:
  • Phone: 310-205-3555
  • Fax:
Mailing address:
  • Phone: 310-205-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: