Healthcare Provider Details

I. General information

NPI: 1902669559
Provider Name (Legal Business Name): PHILIP NGOC VU PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

401 W KENNEDY BLVD APT 1334
TAMPA FL
33606-1450
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8888
  • Fax: 714-456-8888
Mailing address:
  • Phone: 813-253-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64220
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberPA64220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: