Provider Demographics
NPI:1922238385
Name:PHAN, KEVIN VU (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:VU
Last Name:PHAN
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 1:5530 W GRAND PKWY S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5802
Mailing Address - Country:US
Mailing Address - Phone:281-232-1421
Mailing Address - Fax:281-232-1425
Practice Address - Street 1:5530 W GRAND PKWY S
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5802
Practice Address - Country:US
Practice Address - Phone:281-232-1421
Practice Address - Fax:281-232-1425
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice