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General NPI Number Information
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NPI Number | 1225641863
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Entity Type | Individual
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Provider Name | DYLAN QUOC-CHUONG VU DDS
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Gender | Male
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 3945 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-2440
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Country | US
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Telephone | 415-938-7212
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4264
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City | MONTEBELLO
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State | CA
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Zip | 90640-9305
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 11901026-9921
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS105983
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License Number State | CA
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