Provider Demographics
NPI:1922480540
Name:VU, KATY NGOC (DDS)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:NGOC
Last Name:VU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25301 LAS BOLSAS
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5085
Mailing Address - Country:US
Mailing Address - Phone:949-276-1653
Mailing Address - Fax:
Practice Address - Street 1:25401 ALICIA PKWY STE J
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4958
Practice Address - Country:US
Practice Address - Phone:949-587-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist