Healthcare Provider Details

I. General information

NPI: 1568872984
Provider Name (Legal Business Name): ANDY TUAN-ANH VU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N HIATUS RD
PEMBROKE PINES FL
33026-2129
US

IV. Provider business mailing address

525 E 68TH STREET BAKER 21, ORAL & MAXILLOFACIAL SURGERY
NEW YORK NY
10065
US

V. Phone/Fax

Practice location:
  • Phone: 954-738-5895
  • Fax:
Mailing address:
  • Phone: 212-746-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS039692
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN30002
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7769
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401414349
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: