Provider Demographics
NPI:1003029778
Name:VU, NATHAN DUCTHONG (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DUCTHONG
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 1:1009 SOUTH SHAWNEE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:714-728-0567
Mailing Address - Fax:714-508-8011
Practice Address - Street 1:14001 NEWPORT AVE STE C
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7830
Practice Address - Country:US
Practice Address - Phone:714-508-8500
Practice Address - Fax:714-508-8011
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist