Basic Information
| Provider Information | |||||||||
| NPI: | 1003005075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VU | ||||||||
| FirstName: | TOM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 54439 | CA | Y | Dental Providers | Dentist |
No ID Information.