Provider Demographics
NPI:1538194113
Name:VU, TIEN TRONG (MD)
Entity type:Individual
Prefix:
First Name:TIEN
Middle Name:TRONG
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 1:4502 N PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6738
Mailing Address - Country:US
Mailing Address - Phone:209-957-6438
Mailing Address - Fax:209-957-0336
Practice Address - Street 1:4502 N PERSHING AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6738
Practice Address - Country:US
Practice Address - Phone:209-957-6438
Practice Address - Fax:209-957-0336
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34944171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor