Healthcare Provider Details

I. General information

NPI: 1740629435
Provider Name (Legal Business Name): MR. THANH PHU VU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3471 WOODYEND CT
SAN JOSE CA
95121-2548
US

IV. Provider business mailing address

3471 WOODYEND CT
SAN JOSE CA
95121-2548
US

V. Phone/Fax

Practice location:
  • Phone: 408-728-3787
  • Fax:
Mailing address:
  • Phone: 408-728-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: