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General NPI Number Information
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NPI Number | 1427227420
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Entity Type | Organization
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Legal Business Name | NATHAN DUCTHONG VU DDS INC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 14001 NEWPORT AVE STE C
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City | TUSTIN
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State | CA
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Zip | 92780-7830
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Country | US
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Telephone | 714-508-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 14001 NEWPORT AVE STE C
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City | TUSTIN
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State | CA
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Zip | 92780-7830
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Country | US
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Telephone | 714-508-8500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHAN DUCTHONG VU
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Credential | D.D.S.
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Telephone | 714-508-8500
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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 | 49241
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License Number State | CA
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