Provider Demographics
NPI:1003443649
Name:VU, KIM HOANG
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:HOANG
Last Name:VU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 N ORANGE GROVE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3027
Mailing Address - Country:US
Mailing Address - Phone:909-469-9494
Mailing Address - Fax:909-469-2120
Practice Address - Street 1:1770 N ORANGE GROVE AVE STE 101
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3027
Practice Address - Country:US
Practice Address - Phone:909-469-9494
Practice Address - Fax:909-469-2120
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61434421207Q00000X
390200000X
CA20A20004207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program