Provider Demographics
NPI:1679459408
Name:KHIEU, VIVIAN THAO
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:THAO
Last Name:KHIEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15985 CAYENNE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3705
Mailing Address - Country:US
Mailing Address - Phone:858-610-9201
Mailing Address - Fax:
Practice Address - Street 1:15985 CAYENNE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3705
Practice Address - Country:US
Practice Address - Phone:858-610-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program