Provider Demographics
NPI:1043407844
Name:KY T. VU, M.D., INC.
Entity Type:Organization
Organization Name:KY T. VU, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KY
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-501-5798
Mailing Address - Street 1:15642 SUNFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2921
Mailing Address - Country:US
Mailing Address - Phone:714-501-5798
Mailing Address - Fax:714-908-8120
Practice Address - Street 1:17150 EUCLID ST STE 200
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:714-501-5798
Practice Address - Fax:714-908-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH82931Medicare UPIN