Healthcare Provider Details

I. General information

NPI: 1164245502
Provider Name (Legal Business Name): KATHERINE VU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 ATLANTIC AVE STE 108
LONG BEACH CA
90807-4569
US

IV. Provider business mailing address

4615 DURFEE AVE
EL MONTE CA
91732-1723
US

V. Phone/Fax

Practice location:
  • Phone: 562-988-8818
  • Fax:
Mailing address:
  • Phone: 626-548-9915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: