Provider Demographics
NPI:1376658096
Name:VU, DAN (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
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:PO BOX 4428
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-0428
Mailing Address - Country:US
Mailing Address - Phone:562-276-5774
Mailing Address - Fax:562-621-9020
Practice Address - Street 1:2315 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3501
Practice Address - Country:US
Practice Address - Phone:562-621-9231
Practice Address - Fax:562-621-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A486721Medicaid
CAW11981AMedicare ID - Type Unspecified
CAF45642Medicare UPIN