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General NPI Number Information
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NPI Number | 1659798585
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Entity Type | Individual
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Provider Name | MARIE KIM LAN VU N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 1515 S BROADWAY
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City | SANTA ANA
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State | CA
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Zip | 92707-2253
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Country | US
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Telephone | 714-919-0280
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Fax |
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Provider Business Mailing Address
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Address Line | 4010 E CHAPMAN AVE
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City | ORANGE
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State | CA
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Zip | 92869-3990
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Country | US
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Telephone | 323-725-8751
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 817136
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95000534
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License Number State | CA
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