Provider Demographics
NPI:1386733103
Name:VU, NGUYENKHANH D (DDS)
Entity type:Individual
Prefix:
First Name:NGUYENKHANH
Middle Name:D
Last Name:VU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0776
Mailing Address - Country:US
Mailing Address - Phone:714-544-7483
Mailing Address - Fax:714-544-7483
Practice Address - Street 1:14001 NEWPORT AVE
Practice Address - Street 2:#C
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4624
Practice Address - Country:US
Practice Address - Phone:714-508-8500
Practice Address - Fax:714-508-8011
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist