Phung Minh Vu

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40901 Issued in CA

Practice address

6900 N Pecos Rd
North Las Vegas, NV 89086-4400

Phone

(702) 791-9019

NPI assigned

Apr 4, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Riverside San Bernardino County Indian Health Inc

  dba Morango Indian Clinic Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Banning, CA
  • NPI 1902954944
  NPD (past)
• Riverside-San Bernardino County Indian Health, Inc

  dba Santa Rosa Indian Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Mountain Center, CA
  • NPI 1366028086
  NPD (past)
• Riverside-San Bernardino County Indian Health, Inc

  dba Morongo Indian Health

  • Federally Qualified Health Center (FQHC)
  • Banning, CA
  • NPI 1437202124
  NPD (past)
• Riverside-San Bernardino County Indian Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Grand Terrace, CA
  • NPI 1720178478
  NPD (past)
• Riverside-San Bernardino County Indian Health, Inc.

  dba Morongo Indian Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Banning, CA
  • NPI 1841417300
  NPD (past)

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1962524405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42900 BOB HOPE DR",
            "address_2": "SUITE 115",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704442",
            "telephone_number": "760-568-2578",
            "fax_number": "760-568-1372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 N PECOS RD",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890864400",
            "telephone_number": "702-791-9019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11555 Potrero Rd",
            "address_purpose": "LOCATION",
            "city": "Banning",
            "state": "CA",
            "postal_code": "922206946",
            "country_code": "US",
            "telephone_number": "951-849-4761 x245",
            "fax_number": "951-849-4651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VU",
        "first_name": "PHUNG",
        "middle_name": "MINH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ngan Kim Vo Ha, DMD
• Crystal Vodovoz-Martinez
• Merrie Carol Voigt, MA
• Khenh Vong, PHARMD, BCPS
• Katherine Ngoc Vu, D.O
• Parth Jayesh Vyasa, MD
• Alyssa Wachter, CCC-SLP
• Daniel Waddy, BA
• Loreal Wade-Patton
• Delila Nicole Wade

• General Practice Dentistry in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.