Provider Demographics
NPI:1053364505
Name:DANG-VU, CHAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHAN
Middle Name:
Last Name:DANG-VU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1707
Mailing Address - Country:US
Mailing Address - Phone:703-538-2772
Mailing Address - Fax:703-538-2773
Practice Address - Street 1:7297 LEE HWY
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1738
Practice Address - Country:US
Practice Address - Phone:703-538-2772
Practice Address - Fax:703-538-2773
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010415652084P0800X
DCMD176742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7150105Medicaid
4344028OtherAETNA
VA189275OtherANTHEM HEALTH KEEPERS
E23074Medicare UPIN