Individual provider Active NPI

Kenny Khoa Vu, M.D.

  • Family Medicine Physician
  • Dover, DE
National Provider Identifier
1902930811
Registry record updated Apr 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C1-0008350 Issued in DE
Practice address
111 Wolf Creek Blvd
Suite 2
Dover, DE 19901-4969
Phone
(302) 678-0510
Fax
(302) 678-2864
NPI assigned
Mar 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101240716 VA
Student in an Organized Health Care Education/Training Program 390200000X C7-0003034 DE
Family Medicine Physician 207Q00000X C1-0008350 DE Primary

Addresses

Primary practice location

111 Wolf Creek Blvd
Suite 2
Dover, DE 19901-4969

Mailing address

111 Wolf Creek Blvd
Suite 2
Dover, DE 19901-4969
Phone (302) 678-0510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071109000299 DE Practitioner - Family Practice 1658469531 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Medical Centre PAGroup PAC ID 4385732262, 2 clinicians

Practice addresses (Care Compare)

111 Wolf Creek Blvd
Suite 2
Dover, DE 19901-4969
Phone (302) 678-0510

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C1-0008350DEMDFamily Medicine Physician
0101240716VAMDFamily Medicine Physician
C7-0003034DEMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medical Centre PA Family Medicine CurrentSince Sep 1, 2007 Accepting new patients
Nephrology Consultants PA PastSince Sep 1, 2007 Accepting new patients

Locations

111 Wolf Creek Blvd
Ste 2
Dover, DE 19901
Phone (302) 678-0510

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/3c97fd5e-8596-4941-825c-71277aadd345/
  • Direct secure messaging: kenny.vu.1@19734.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428537600000",
    "number": "1902930811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 WOLF CREEK BLVD",
            "address_2": "SUITE 2",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199014969",
            "telephone_number": "302-678-0510",
            "fax_number": "302-678-2864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 WOLF CREEK BLVD",
            "address_2": "SUITE 2",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199014969",
            "telephone_number": "302-678-0510",
            "fax_number": "302-678-2864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VU",
        "first_name": "KENNY",
        "middle_name": "KHOA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2015-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101240716",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "DE",
            "license": "C7-0003034",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C1-0008350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

Verify at the official NPI Registry.