Basic Information
Provider Information
NPI: 1003005075
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VU
FirstName: TOM
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4955 VAN NUYS BLVD
Address2: SUITE #518
City: SHERMAN OAKS
State: CA
PostalCode: 91403
CountryCode: US
TelephoneNumber: 8187838891
FaxNumber: 8187832648
Practice Location
Address1: 4955 VAN NUYS BLVD
Address2: SUITE #518
City: SHERMAN OAKS
State: CA
PostalCode: 91403
CountryCode: US
TelephoneNumber: 8187838891
FaxNumber: 8187832648
Other Information
ProviderEnumerationDate: 10/16/2007
LastUpdateDate: 06/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X54439CAY Dental ProvidersDentist 

No ID Information.


Home