Healthcare Provider Details

I. General information

NPI: 1720548498
Provider Name (Legal Business Name): KHANG VU VU PARAMOUNT DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 ALONDRA BLVD STE A
PARAMOUNT CA
90723-4356
US

IV. Provider business mailing address

8050 ALONDRA BLVD STE A
PARAMOUNT CA
90723-4356
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-5904
  • Fax: 562-630-0799
Mailing address:
  • Phone: 562-630-5904
  • Fax: 562-630-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: KHANG VU
Title or Position: OWNER
Credential: DDS
Phone: 562-630-5904