Individual
THU KIM VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
12902 BROOKHURST ST, SUITE B, GARDEN GROVE, CA 92840-4881
(714) 636-3211
(714) 636-5956
Mailing address
12902 BROOKHURST ST, SUITE B, GARDEN GROVE, CA 92840-4881
(714) 636-3211
(714) 636-5956
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E3686
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GRE000290
—
CA
Enumeration date
04/13/2006
Last updated
03/08/2011
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