MEDICARE: PHILIP NGOC VU PA-C

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	363A00000X	Physician Assistant	PA64220	CA
2	207Y00000X	Otolaryngology Physician	PA64220	CA

General Provider Information

NPI Number	:	1902669559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP NGOC VU PA-C

Provider Business Mailing Address
First Line	:	401 W KENNEDY BLVD APT 1334
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1450
Country	:	US
Telephone Number	:	813-253-6249
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 THE CITY DR S
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3201
Country	:	US
Telephone Number	:	714-456-8888
Fax Number	:	714-456-8888

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	03/18/2026

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