Provider Demographics
NPI:1780790139
Name:VU, LINH PHUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:LINH
Middle Name:PHUONG
Last Name:VU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 MANDEVILLE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2222
Mailing Address - Country:US
Mailing Address - Phone:310-471-9551
Mailing Address - Fax:
Practice Address - Street 1:609 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2507
Practice Address - Country:US
Practice Address - Phone:310-394-4881
Practice Address - Fax:310-394-8113
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice