Healthcare Provider Details

I. General information

NPI: 1932050192
Provider Name (Legal Business Name): KONG MENG VANG PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 N DE WOLF AVE
CLOVIS CA
93619-9239
US

IV. Provider business mailing address

7380 N DE WOLF AVE
CLOVIS CA
93619-9239
US

V. Phone/Fax

Practice location:
  • Phone: 559-430-5793
  • Fax:
Mailing address:
  • Phone: 559-430-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250085445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: