=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912144114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOM VU DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2009
-----------------------------------------------------
Last Update Date | 08/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7171 WARNER AVE SUITE #C
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-5478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-842-7000
-----------------------------------------------------
Fax | 714-842-7311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7171 WARNER AVE SUITE #C
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-5478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-842-7000
-----------------------------------------------------
Fax | 714-842-7311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. TOM T VU
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 714-357-9958
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------