Provider Demographics
NPI:1285934190
Name:VU, SUONG T
Entity type:Individual
Prefix:MS
First Name:SUONG
Middle Name:T
Last Name:VU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1905
Mailing Address - Country:US
Mailing Address - Phone:619-284-3582
Mailing Address - Fax:619-284-0619
Practice Address - Street 1:4145 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1905
Practice Address - Country:US
Practice Address - Phone:619-284-3582
Practice Address - Fax:619-284-0619
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist