1871520809 NPI number — TUANTU VU PHYSICIAN ASSISTANT

Table of content: TUANTU VU PHYSICIAN ASSISTANT (NPI 1871520809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871520809 NPI number — TUANTU VU PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VU
Provider First Name:
TUANTU
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOAN VU
Provider Other First Name:
TUANTU
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICIAN ASSISTANT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871520809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2969E SALEM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-4982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-285-3884
Provider Business Mailing Address Fax Number:
559-298-6441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2969 E SALEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-4982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-285-3884
Provider Business Practice Location Address Fax Number:
559-298-6441
Provider Enumeration Date:
06/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA 14120 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA14120 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)