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General NPI Number Information
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NPI Number | 1093983066
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Entity Type | Individual
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Provider Name | KHOA DANG VU M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1800 HARRISON ST 7TH FLOOR
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City | OAKLAND
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State | CA
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Zip | 94612-3466
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Country | US
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Telephone | 510-625-5947
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Fax | 510-625-5487
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Provider Business Mailing Address
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Address Line | 38 SEMINOLE AVE BASEMENT
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City | ALBANY
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State | NY
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Zip | 12203-2538
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Country | US
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Telephone | 571-230-4800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A102500
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License Number State | CA
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