=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710258603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANH P DANG-VU, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2012
-----------------------------------------------------
Last Update Date | 01/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 ELDEN ST STE E
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20170-4832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-925-1886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 ELDEN ST STE E
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20170-4832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-925-1886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANH P DANG-VU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 703-925-1886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 0101046603
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------