Provider Demographics
NPI:1417131749
Name:VU, TIEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIEN
Middle Name:D
Last Name:VU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TIEN
Other - Middle Name:D
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5010 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2519
Mailing Address - Country:US
Mailing Address - Phone:714-470-1443
Mailing Address - Fax:714-470-1443
Practice Address - Street 1:5010 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2519
Practice Address - Country:US
Practice Address - Phone:714-470-1443
Practice Address - Fax:714-470-1443
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice