Healthcare Provider Details

I. General information

NPI: 1467372888
Provider Name (Legal Business Name): MAI ONG VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 W SHAW AVE STE 101
FRESNO CA
93711-3242
US

IV. Provider business mailing address

PO BOX 2371
CLOVIS CA
93613-2371
US

V. Phone/Fax

Practice location:
  • Phone: 559-202-3423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number139502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: