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General NPI Number Information
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NPI Number | 1154408789
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Entity Type | Organization
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Legal Business Name | CUONG TAT VU M.D.INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 412 8TH ST B
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City | OAKLAND
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State | CA
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Zip | 94607-3983
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Country | US
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Telephone | 510-452-4690
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Fax |
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Provider Business Mailing Address
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Address Line | 412 8TH ST B
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City | OAKLAND
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State | CA
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Zip | 94607-3983
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Country | US
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Telephone | 510-452-4690
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CUONG TAT VU
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Credential | M.D
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Telephone | 510-452-4690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A36563
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License Number State | CA
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