Provider Demographics
NPI:1700838018
Name:VU, YEN P (OD)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:P
Last Name:VU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12081 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3332
Mailing Address - Country:US
Mailing Address - Phone:714-741-3937
Mailing Address - Fax:714-638-3689
Practice Address - Street 1:12081 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3332
Practice Address - Country:US
Practice Address - Phone:714-741-3937
Practice Address - Fax:714-638-3689
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11774T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0011774Medicaid
AZU99774Medicare UPIN