Healthcare Provider Details

I. General information

NPI: 1265040232
Provider Name (Legal Business Name): KAO HOUA VANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 SHAW AVE
CLOVIS CA
93611-8919
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-272-2251
  • Fax: 559-272-2252
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA189871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: