Basic Information
| Provider Information | |||||||||
| NPI: | 1568426740 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VU | ||||||||
| FirstName: | VINH | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39765 DATE ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925632005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146651600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1035 S MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | FALLBROOK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920283338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145491300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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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 | 207R00000X | C52540 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00755268 | 01 | CA | MEDICARE RR | OTHER | 00C525400 | 05 | CA | MEDICAID |