Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 44798 | CA |
NPI | 1003863556 |
---|---|
Provider Name | Kevin Vu |
First Address | San Jose, CA 95132-1017 |
Second Address | San Jose, CA 95132-1017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 15/08/2013 |