Healthcare Provider Details

I. General information

NPI: 1558287128
Provider Name (Legal Business Name): BENNY VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N KENDOR DR
ANAHEIM CA
92801-4847
US

IV. Provider business mailing address

223 N KENDOR DR
ANAHEIM CA
92801-4847
US

V. Phone/Fax

Practice location:
  • Phone: 714-613-3192
  • Fax:
Mailing address:
  • Phone: 714-613-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number259859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: