Healthcare Provider Details

I. General information

NPI: 1144642687
Provider Name (Legal Business Name): VU HOANG CHAU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 04/04/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 W 1ST ST SPC 78
SANTA ANA CA
92703-3141
US

IV. Provider business mailing address

4801 W 1ST ST SPC 78
SANTA ANA CA
92703-3141
US

V. Phone/Fax

Practice location:
  • Phone: 714-425-7740
  • Fax:
Mailing address:
  • Phone: 714-425-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9502317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: