Basic Information
| Provider Information | |||||||||
| NPI: | 1003443649 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VU | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | HOANG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2505 W 16TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927063121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142479038 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1770 N ORANGE GROVE AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917673027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094699494 | ||||||||
| FaxNumber: | 9094692120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2020 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.