Provider Demographics
NPI:1316912199
Name:VU, KHAI T (DO)
Entity type:Individual
Prefix:DR
First Name:KHAI
Middle Name:T
Last Name:VU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-992-0060
Mailing Address - Fax:740-992-5762
Practice Address - Street 1:88 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9569
Practice Address - Country:US
Practice Address - Phone:740-992-0060
Practice Address - Fax:740-992-5762
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006210207R00000X
OH34-006210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810027007Medicaid
OH2616440Medicaid
OH7412451OtherMEDICARE PTAN
OH3618821OtherGROUP ORGANIZATION PTAN
OHVU4170822Medicare PIN
OHG25766Medicare UPIN
OHH140496Medicare PIN
OH7412451OtherMEDICARE PTAN