Provider Demographics
NPI:1902930811
Name:VU, KENNY KHOA (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:KHOA
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 1:111 WOLF CREEK BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4969
Mailing Address - Country:US
Mailing Address - Phone:302-678-0510
Mailing Address - Fax:302-678-2864
Practice Address - Street 1:111 WOLF CREEK BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4969
Practice Address - Country:US
Practice Address - Phone:302-678-0510
Practice Address - Fax:302-678-2864
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240716207Q00000X
DEC7-0003034390200000X
DEC1-0008350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DERES001Medicare UPIN