Healthcare Provider Details

I. General information

NPI: 1356578652
Provider Name (Legal Business Name): THUY-ANH HOANG VU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THUY-ANH VU MD, PLLC

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 08/12/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 HAMAKER COUURT SUITE 300
FAIRFAX VA
22031-2247
US

IV. Provider business mailing address

9617 JOMAR DR
FAIRFAX VA
22032-2014
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-2788
  • Fax: 571-405-5720
Mailing address:
  • Phone: 571-276-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116021341
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number0101254994
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: