Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 74675 | MA |
NPI | 1023057023 |
---|---|
Provider Name | Hieu Khac Vu |
First Address | Milton, MA 02186-4118 |
Second Address | Dorchester, MA 02125-1520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 08/07/2007 |