Healthcare Provider Details

I. General information

NPI: 1639397748
Provider Name (Legal Business Name): MARTIN NHUT VUONG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7285 QUILL DR
DOWNEY CA
90242-2001
US

IV. Provider business mailing address

300 W GRAND AVE APT 29
ALHAMBRA CA
91801-7220
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-8826
  • Fax:
Mailing address:
  • Phone: 714-856-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: