Provider Demographics
NPI:1487820213
Name:VU, KHANH CONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:CONG
Last Name:VU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12790 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2048
Mailing Address - Country:US
Mailing Address - Phone:281-580-7620
Mailing Address - Fax:281-580-0466
Practice Address - Street 1:7515 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2101
Practice Address - Country:US
Practice Address - Phone:713-723-7855
Practice Address - Fax:713-723-5772
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1663544-04Medicaid
TXG60040-02OtherTEXAS CHIP
TX1663544-02Medicaid
TXG60040-01OtherTEXAS CHIP
TXG60040-04OtherTEXAS CHIP
TX1663544-01Medicaid
TXG60040-03OtherTEXAS CHIP
TX1663544-05Medicaid
TXG60040-05OtherTEXAS CHIP
TXG60040-06OtherTEXAS CHIP
TX1663544-03Medicaid