MEDICARE: DR. HUYNH-TRUONG VU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	11024	NV
2	208000000X	Pediatrics Physician	A88943	CA

General Provider Information

NPI Number	:	1659358935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUYNH-TRUONG VU MD

Provider Business Mailing Address
First Line	:	5586 S FORT APACHE RD
Second Line	:	#100 SOUTHERN NEVADA NEONATAL SERVICES INC
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3619
Country	:	US
Telephone Number	:	702-384-8099
Fax Number	:	702-384-3930

Provider Business Practice Location Address
First Line	:	5586 S FORT APACHE RD
Second Line	:	#100 SOUTHERN NEVADA NEONATAL SERVICES INC
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3619
Country	:	US
Telephone Number	:	702-384-8099
Fax Number	:	702-384-3930

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/08/2007

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