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General NPI Number Information
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NPI Number | 1770133704
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Entity Type | Individual
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Provider Name | TOM VU
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Gender | Male
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 631 S BROOKHURST ST STE 101
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City | ANAHEIM
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State | CA
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Zip | 92804-3563
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Country | US
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Telephone | 714-991-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 12681 ANABEL AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4204
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Country | US
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Telephone | 714-548-9625
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA57203
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License Number State | CA
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