Provider Demographics
NPI:1043261936
Name:VU, BAN Q (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:BAN
Middle Name:Q
Last Name:VU
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:BAN
Other - Middle Name:Q
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICAL DOCTOR
Mailing Address - Street 1:14571 MAGNOLIA ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-894-6233
Mailing Address - Fax:
Practice Address - Street 1:14571 MAGNOLIA ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-894-6233
Practice Address - Fax:714-894-6211
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A346060OtherMEDICAL
CAA34606Medicare ID - Type Unspecified
A84661Medicare UPIN