Provider Demographics
NPI:1982012118
Name:LUU, PHONG VU (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHONG
Middle Name:VU
Last Name:LUU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 SISKIN AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6553
Mailing Address - Country:US
Mailing Address - Phone:714-757-7976
Mailing Address - Fax:
Practice Address - Street 1:4901 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1415
Practice Address - Country:US
Practice Address - Phone:626-652-6915
Practice Address - Fax:626-652-6917
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65065183500000X
NV17937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist