Healthcare Provider Details

I. General information

NPI: 1578604328
Provider Name (Legal Business Name): TRUNG QUANG VU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 53 RM 204
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S BLDG 53 RM 204
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7002
  • Fax: 714-456-7321
Mailing address:
  • Phone: 714-456-7002
  • Fax: 714-456-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA108548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: