Provider Demographics
NPI:1679570717
Name:VU, KHANH TUAN (MD)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:TUAN
Last Name: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 1:381 RUIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2932
Mailing Address - Country:US
Mailing Address - Phone:252-430-0666
Mailing Address - Fax:252-430-7503
Practice Address - Street 1:381 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2932
Practice Address - Country:US
Practice Address - Phone:252-430-0666
Practice Address - Fax:252-430-7503
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985163Medicaid
NCB91233Medicare UPIN
NC2184151Medicare ID - Type Unspecified