Healthcare Provider Details

I. General information

NPI: 1104730498
Provider Name (Legal Business Name): KEVIN TUAN VU RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3552 S NORTH SHORE DR
ONTARIO CA
91761-9130
US

IV. Provider business mailing address

3552 S NORTH SHORE DR
ONTARIO CA
91761-9130
US

V. Phone/Fax

Practice location:
  • Phone: 909-461-0953
  • Fax:
Mailing address:
  • Phone: 909-461-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number138715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: