Provider Demographics
NPI:1699795427
Name:VU, PHUONG HONG (OD)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:HONG
Last Name:VU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3802
Mailing Address - Country:US
Mailing Address - Phone:562-438-9438
Mailing Address - Fax:562-438-9430
Practice Address - Street 1:3000 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3802
Practice Address - Country:US
Practice Address - Phone:562-438-9438
Practice Address - Fax:562-438-9430
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12080T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0120800Medicaid
CASD0120800Medicaid