Provider Demographics
NPI:1003005075
Name:VU, TOM (DMD)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:VU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:SUITE #518
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-783-8891
Mailing Address - Fax:818-783-2648
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:SUITE #518
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-783-8891
Practice Address - Fax:818-783-2648
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist