=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427354521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE THANH-THAO VU D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2011
-----------------------------------------------------
Last Update Date | 02/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 E ARQUES AVE SUITE 212
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94085-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-749-9018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 816 N DELAWARE ST # 402
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94401-1574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-406-3756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 56672
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------