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General NPI Number Information
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NPI Number | 1386733103
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Entity Type | Individual
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Provider Name | NGUYENKHANH D VU D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14001 NEWPORT AVE #C
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City | TUSTIN
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State | CA
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Zip | 92780-4624
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Country | US
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Telephone | 714-508-8500
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Fax | 714-508-8011
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Provider Business Mailing Address
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Address Line | 9 CARRIAGE DR
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City | IRVINE
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State | CA
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Zip | 92602-0776
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Country | US
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Telephone | 714-544-7483
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Fax | 714-544-7483
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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 | 48693
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License Number State | CA
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