Basic Information
| Provider Information | |||||||||
| NPI: | 1841270956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VU | ||||||||
| FirstName: | KIM-ANH | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 E 20TH ST | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410141583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596557171 | ||||||||
| FaxNumber: | 8596556742 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | COLD SPRING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410760000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594421500 | ||||||||
| FaxNumber: | 8594421501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 04/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35081958 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000571106 | 01 | KY | ANTHEM | OTHER | 2275138 | 05 | OH | MEDICAID |