Healthcare Provider Details

I. General information

NPI: 1386733483
Provider Name (Legal Business Name): GIANG VAN VU PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 PACIFIC AVE S
TACOMA WA
98444-5525
US

IV. Provider business mailing address

101 E 26TH ST
TACOMA WA
98421-1108
US

V. Phone/Fax

Practice location:
  • Phone: 253-536-2020
  • Fax: 253-536-5327
Mailing address:
  • Phone: 253-597-4550
  • Fax: 253-597-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10005057
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: