Healthcare Provider Details

I. General information

NPI: 1487820213
Provider Name (Legal Business Name): KHANH CONG VU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 W BELLFORT ST
HOUSTON TX
77071-2101
US

IV. Provider business mailing address

12790 VETERANS MEMORIAL DR
HOUSTON TX
77014-2048
US

V. Phone/Fax

Practice location:
  • Phone: 713-723-7855
  • Fax: 713-723-5772
Mailing address:
  • Phone: 281-580-7620
  • Fax: 281-580-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: