Individual provider Active NPI

Son N Vu, DDS

  • Dentist
  • Huntington Beach, CA
National Provider Identifier
1407045271
Registry record updated Mar 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
59072 Issued in CA
Practice address
19432 Hickory LN
Huntington Beach, CA 92646-2748
Phone
(714) 300-8716
NPI assigned
Oct 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 23587 TX
Dentist 122300000X 59072 CA Primary

Addresses

Primary practice location

19432 Hickory LN
Huntington Beach, CA 92646-2748

Mailing address

19432 Hickory LN
Huntington Beach, CA 92646-2748
Phone (714) 300-8716

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140819000806 CA Practitioner - DentistPractitioner - Oral Surgery 0244457091 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23587TXMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fulbright Dental Group, PC CurrentSince Jun 22, 2019 Accepting new patients

Locations

5220 Pacific Concourse Dr
Ste 120
Los Angeles, CA 90045
Phone (310) 228-0396

1801 W Olympic Blvd
#1738
Pasadena, CA 91199

188 Frank West Cir
Ste G
Stockton, CA 95206
Phone (310) 337-1694

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395273600000",
    "number": "1407045271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19432 HICKORY LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926462748",
            "telephone_number": "714-300-8716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19432 HICKORY LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926462748",
            "telephone_number": "714-300-8716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VU",
        "first_name": "SON",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2014-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "23587",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "59072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

Verify at the official NPI Registry.