Provider Demographics
NPI:1811085590
Name:VU, THANH NGOC (DO)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:NGOC
Last Name:VU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2604 E CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4679
Mailing Address - Country:US
Mailing Address - Phone:316-684-9900
Mailing Address - Fax:316-684-9901
Practice Address - Street 1:2604 E CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4679
Practice Address - Country:US
Practice Address - Phone:316-684-9900
Practice Address - Fax:316-684-9901
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-28430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100345240BMedicaid
H08697Medicare UPIN
042744Medicare ID - Type Unspecified