Basic Information
| Provider Information | |||||||||
| NPI: | 1427522457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VU | ||||||||
| FirstName: | MINH | ||||||||
| MiddleName: | QUANG | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4643 PARK NORTON PL | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951362523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088931261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317554111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2019 | ||||||||
| LastUpdateDate: | 01/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 124597 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 124597 | 01 | CA | NBCRNA | OTHER | 835978 | 01 | CA | CA BOARD OF REGISTERED NURSING | OTHER | 836535 | 01 | TX | TX BOARD OF NURSING | OTHER |