Provider Demographics
NPI:1366484446
Name:VU, CHUONG HOANG (MD)
Entity Type:Individual
Prefix:
First Name:CHUONG
Middle Name:HOANG
Last Name:VU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 DAVID WALKER DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5745
Mailing Address - Country:US
Mailing Address - Phone:352-742-8830
Mailing Address - Fax:352-742-8826
Practice Address - Street 1:1755 DAVID WALKER DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5745
Practice Address - Country:US
Practice Address - Phone:352-742-8830
Practice Address - Fax:352-742-8826
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080140343OtherRAILROAD MEDICARE
FL42745OtherBCBS
FL254077100Medicaid
080140343OtherRAILROAD MEDICARE
G67498Medicare UPIN