Healthcare Provider Details

I. General information

NPI: 1720741879
Provider Name (Legal Business Name): MAI TU VUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 E LA PALMA AVE
ANAHEIM CA
92806-2020
US

IV. Provider business mailing address

1321 S DEL MAR AVE
SAN GABRIEL CA
91776-3315
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 626-731-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3156659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: