Healthcare Provider Details

I. General information

NPI: 1922922277
Provider Name (Legal Business Name): KRISTINA VU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 PROSPECT ST
LA JOLLA CA
92037-4200
US

IV. Provider business mailing address

3005 OSCEOLA AVE
SAN DIEGO CA
92117-1612
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-2897
  • Fax:
Mailing address:
  • Phone: 858-349-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: