Provider Demographics
NPI:1386755270
Name:VU, THU BAO TRUNG (MD)
Entity type:Individual
Prefix:
First Name:THU
Middle Name:BAO TRUNG
Last Name:VU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2478 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2546
Mailing Address - Country:US
Mailing Address - Phone:503-362-2481
Mailing Address - Fax:503-375-8700
Practice Address - Street 1:2478 13TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2546
Practice Address - Country:US
Practice Address - Phone:503-362-2481
Practice Address - Fax:503-375-8700
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203049208000000X
WAMD60100602208000000X
ORMD175111208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2197835Medicaid
OR500696788Medicaid