Healthcare Provider Details

I. General information

NPI: 1043474679
Provider Name (Legal Business Name): VUONG AND PHAM, A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2008
Last Update Date: 07/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17150 EUCLID ST STE 319
FOUNTAIN VALLEY CA
92708-4092
US

IV. Provider business mailing address

17150 EUCLID ST STE 319
FOUNTAIN VALLEY CA
92708-4092
US

V. Phone/Fax

Practice location:
  • Phone: 714-444-2274
  • Fax: 714-444-2034
Mailing address:
  • Phone: 714-444-2274
  • Fax: 714-444-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number00067
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number45419
License Number StateCA

VIII. Authorized Official

Name: DR. AN HONG VUONG
Title or Position: OWNER
Credential: D.D.S., M.D.
Phone: 714-444-2274