Healthcare Provider Details

I. General information

NPI: 1154408789
Provider Name (Legal Business Name): CUONG TAT VU M.D.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 8TH ST B
OAKLAND CA
94607-3983
US

IV. Provider business mailing address

412 8TH ST B
OAKLAND CA
94607-3983
US

V. Phone/Fax

Practice location:
  • Phone: 510-452-4690
  • Fax:
Mailing address:
  • Phone: 510-452-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA36563
License Number StateCA

VIII. Authorized Official

Name: DR. CUONG TAT VU
Title or Position: PRESIDENT
Credential: M.D
Phone: 510-452-4690