Provider Demographics
NPI:1689960734
Name:KHIEM VU DOPA
Entity Type:Organization
Organization Name:KHIEM VU DOPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHIEM
Authorized Official - Middle Name:QUYNH
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-582-5777
Mailing Address - Street 1:2700 CITIZENS PLAZA,
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-582-5777
Mailing Address - Fax:
Practice Address - Street 1:2700 CITIZENS PLAZA,
Practice Address - Street 2:SUITE 400
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-582-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty