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General NPI Number Information
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NPI Number | 1730346529
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Entity Type | Organization
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Legal Business Name | PHONG THIEN VU, M.D., INC.
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 17772 BEACH BLVD
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-6819
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Country | US
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Telephone | 714-842-1473
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 800-883-7243
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Fax | 714-647-1245
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHONG THIEN VU
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Credential | M.D.
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Telephone | 800-883-7243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A71476
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A71476
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License Number State | CA
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