Provider Demographics
NPI:1255823548
Name:VU, KEVIN DINH (RPH)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DINH
Last Name:VU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 E ONTARIO AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-6604
Mailing Address - Country:US
Mailing Address - Phone:951-582-0739
Mailing Address - Fax:951-582-0787
Practice Address - Street 1:1375 E ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6604
Practice Address - Country:US
Practice Address - Phone:951-582-0739
Practice Address - Fax:951-582-0787
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49321OtherPHARMACIST LICENSE