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General NPI Number Information
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NPI Number | 1174106181
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Entity Type | Individual
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Provider Name | TIARA VU-NGUYEN OD
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Gender | Female
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 115 TECHNOLOGY DR
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City | IRVINE
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State | CA
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Zip | 92618-2408
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Country | US
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Telephone | 949-453-8409
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Fax |
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Provider Business Mailing Address
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Address Line | 17164 SANTA BARBARA ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3313
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Country | US
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Telephone | 714-878-0425
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT34862TLG
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License Number State | CA
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