Healthcare Provider Details

I. General information

NPI: 1184166985
Provider Name (Legal Business Name): KY VAN VUONG PSYD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 10/16/2026
Certification Date: 10/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31ST MEDICAL GROUP VIA PEDEMONTE, BLDG 121
APO AE
09604-0049
US

IV. Provider business mailing address

31ST MEDICAL GROUP OPC 103 BOX 49
APO AE
09604-0049
US

V. Phone/Fax

Practice location:
  • Phone: 314-632-5459
  • Fax:
Mailing address:
  • Phone: 314-632-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007599
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-25581
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: