Provider Demographics
NPI:1922730241
Name:VU, ALLIE THAO (CSA)
Entity Type:Individual
Prefix:MISS
First Name:ALLIE
Middle Name:THAO
Last Name:VU
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:MISS
Other - First Name:ALLIE
Other - Middle Name:THAO
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSA
Mailing Address - Street 1:PO BOX 221135
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20153-1135
Mailing Address - Country:US
Mailing Address - Phone:703-259-7027
Mailing Address - Fax:703-591-0005
Practice Address - Street 1:12011 LEE JACKSON HWY STE 501
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3315
Practice Address - Country:US
Practice Address - Phone:703-259-7027
Practice Address - Fax:703-591-0005
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000679246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant