Provider Demographics
NPI:1164060869
Name:VU, KIM NGAN
Entity Type:Individual
Prefix:
First Name:KIM NGAN
Middle Name:
Last Name:VU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3800 N TARRANT PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5416
Mailing Address - Country:US
Mailing Address - Phone:682-593-6660
Mailing Address - Fax:
Practice Address - Street 1:3800 N TARRANT PKWY STE 210
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5416
Practice Address - Country:US
Practice Address - Phone:682-593-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily