1487820213 NPI number — DR. KHANH CONG VU D.D.S.

Table of content: DR. KHANH CONG VU D.D.S. (NPI 1487820213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487820213 NPI number — DR. KHANH CONG VU D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VU
Provider First Name:
KHANH
Provider Middle Name:
CONG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487820213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12790 VETERANS MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77014-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-580-7620
Provider Business Mailing Address Fax Number:
281-580-0466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7515 W BELLFORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77071-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-723-7855
Provider Business Practice Location Address Fax Number:
713-723-5772
Provider Enumeration Date:
05/01/2008

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: 122300000X , with the licence number:  21743 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1663544-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G60040-02 . This is a "TEXAS CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1663544-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G60040-01 . This is a "TEXAS CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: G60040-04 . This is a "TEXAS CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1663544-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G60040-03 . This is a "TEXAS CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1663544-05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G60040-05 . This is a "TEXAS CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: G60040-06 . This is a "TEXAS CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1663544-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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