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NPI Code Detail

MEDICARE: THAI NGOC VU MD

MEDICARE: THAI NGOC 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
1207Q00000XFamily Medicine Physician80691MN

General Provider Information

NPI Number : 1952041816
Entity Type Code : Individual
Provider Name (Legal Business Name) : THAI NGOC VU MD
Provider Business Mailing Address
First Line : 5700 BOTTINEAU BLVD STE 100
Second Line :
City : CRYSTAL
State : MN
Zip : 55429-3184
Country : US
Telephone Number : 763-504-6500
Fax Number : 763-537-1972
Provider Business Practice Location Address
First Line : 5700 BOTTINEAU BLVD STE 100
Second Line :
City : CRYSTAL
State : MN
Zip : 55429-3184
Country : US
Telephone Number : 763-504-6500
Fax Number : 763-537-1972
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2022
Last Update Date : 12/11/2025

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