Healthcare Provider Details

I. General information

NPI: 1861429235
Provider Name (Legal Business Name): AN CONG VU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VILLA RD
NEWBERG OR
97132-1857
US

IV. Provider business mailing address

11110 NW MONTREUX LANE
PORTLAND OR
97229
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-7331
  • Fax: 503-538-7333
Mailing address:
  • Phone: 503-646-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD14665
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: