1477609964 NPI number — JENNIFER NGUYEN VU DDS

Table of content: JENNIFER NGUYEN VU DDS (NPI 1477609964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477609964 NPI number — JENNIFER NGUYEN VU DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VU
Provider First Name:
JENNIFER
Provider Middle Name:
NGUYEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
THU HUONG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477609964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12940 FOOTHILL BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SYLMAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-837-4433
Provider Business Mailing Address Fax Number:
818-837-6644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12940 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-837-4433
Provider Business Practice Location Address Fax Number:
818-837-6644
Provider Enumeration Date:
01/26/2007

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: 1223G0001X , with the licence number:  44426 , 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)

  • Identifier: B4442601 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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