Provider Demographics
NPI:1871611434
Name:VU, KEVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:VU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:211 BAKER RD UNIT 222
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:TX
Mailing Address - Zip Code:77413-6011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1520 S MASON RD STE B
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-4572
Practice Address - Country:US
Practice Address - Phone:832-766-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120933001Medicaid