Provider Demographics
NPI:1518521525
Name:VU, LINCOLN KENNEDY (NP-C)
Entity Type:Individual
Prefix:
First Name:LINCOLN
Middle Name:KENNEDY
Last Name:VU
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-2914
Mailing Address - Country:US
Mailing Address - Phone:818-430-9861
Mailing Address - Fax:
Practice Address - Street 1:9330 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3838
Practice Address - Country:US
Practice Address - Phone:818-430-9861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner