Provider Demographics
NPI:1659199875
Name:VU, BAO QUYEN UYEN
Entity type:Individual
Prefix:
First Name:BAO QUYEN
Middle Name:UYEN
Last Name:VU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13321 DANVERS WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1719
Mailing Address - Country:US
Mailing Address - Phone:714-548-5306
Mailing Address - Fax:714-845-9808
Practice Address - Street 1:14571 MAGNOLIA STREET #201
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-548-5306
Practice Address - Fax:714-845-9808
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95218258163W00000X
CAAG12240046363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse