Healthcare Provider Details

I. General information

NPI: 1659798585
Provider Name (Legal Business Name): MARIE KIM LAN VU N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S BROADWAY
SANTA ANA CA
92707-2253
US

IV. Provider business mailing address

4010 E CHAPMAN AVE
ORANGE CA
92869-3990
US

V. Phone/Fax

Practice location:
  • Phone: 714-919-0280
  • Fax:
Mailing address:
  • Phone: 323-725-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number817136
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: