Healthcare Provider Details

I. General information

NPI: 1548164494
Provider Name (Legal Business Name): HAN T VU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7036 DRYSDALE ST
RIVERSIDE CA
92503-1121
US

IV. Provider business mailing address

7036 DRYSDALE ST
RIVERSIDE CA
92503-1121
US

V. Phone/Fax

Practice location:
  • Phone: 714-363-6899
  • Fax:
Mailing address:
  • Phone: 714-363-6899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95319549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: