Provider Demographics
NPI:1336252279
Name:VU, THONG TIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:THONG
Middle Name:TIEN
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 1:6 ROBLEDO DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3059
Mailing Address - Country:US
Mailing Address - Phone:817-459-1585
Mailing Address - Fax:817-303-4009
Practice Address - Street 1:2420 E ARKANSAS LN
Practice Address - Street 2:#246
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-1762
Practice Address - Country:US
Practice Address - Phone:817-459-1585
Practice Address - Fax:817-303-4009
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130940303Medicaid
TX130940306Medicaid
TX751700137OtherFEDERAL TAX ID
TX751700137OtherFEDERAL TAX ID
TX130940303Medicaid