Provider Demographics
NPI:1942497292
Name:HUYNH TRUONG PHAM VU MD LTD
Entity Type:Organization
Organization Name:HUYNH TRUONG PHAM VU MD LTD
Other - Org Name:ANTHEM PREDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUYNH TRUONG
Authorized Official - Middle Name:PHAM
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-263-7800
Mailing Address - Street 1:866 SEVEN HILLS DR
Mailing Address - Street 2:SUITE #103
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-263-7800
Mailing Address - Fax:702-263-0087
Practice Address - Street 1:866 SEVEN HILLS DR
Practice Address - Street 2:SUITE #103
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-263-7800
Practice Address - Fax:702-263-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11024208000000X
CAA88943208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty