Provider Demographics
NPI:1962667949
Name:VU, JOHNATHAN ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:ANDREW
Last Name:VU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14981 BALLOU CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6712
Mailing Address - Country:US
Mailing Address - Phone:714-839-3112
Mailing Address - Fax:
Practice Address - Street 1:9972 BOLSA AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6069
Practice Address - Country:US
Practice Address - Phone:714-839-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice