Provider Demographics
NPI:1336223502
Name:VU, DANIEL THIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THIEN
Last Name:VU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-2232
Mailing Address - Country:US
Mailing Address - Phone:559-222-5759
Mailing Address - Fax:559-222-4457
Practice Address - Street 1:2021 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2232
Practice Address - Country:US
Practice Address - Phone:559-222-5759
Practice Address - Fax:559-222-4457
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A353510Medicaid
CA00A353510Medicare ID - Type UnspecifiedMEDICARE
CA00A353510Medicaid