Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 49241 | CA |
NPI | 1003029778 |
---|---|
Provider Name | Nathan Ducthong Vu |
First Address | Santa Ana, CA 92704 |
Second Address | Tustin, CA 92780-7830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 12/10/2007 |