Provider Demographics
NPI:1255416764
Name:KIM-ANH THI VU, D.D.S., INC.
Entity type:Organization
Organization Name:KIM-ANH THI VU, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM-ANH
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-288-9797
Mailing Address - Street 1:8244 E. GARVEY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2566
Mailing Address - Country:US
Mailing Address - Phone:626-288-9797
Mailing Address - Fax:626-312-5380
Practice Address - Street 1:8244 GARVEY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2566
Practice Address - Country:US
Practice Address - Phone:626-288-9797
Practice Address - Fax:626-312-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty