Provider Demographics
NPI:1720548498
Name:KHANG VU VU PARAMOUNT DENTAL GROUP
Entity Type:Organization
Organization Name:KHANG VU VU PARAMOUNT DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-630-5904
Mailing Address - Street 1:8050 ALONDRA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4356
Mailing Address - Country:US
Mailing Address - Phone:562-630-5904
Mailing Address - Fax:562-630-0799
Practice Address - Street 1:8050 ALONDRA BLVD STE A
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4356
Practice Address - Country:US
Practice Address - Phone:562-630-5904
Practice Address - Fax:562-630-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9372801Medicaid