Healthcare Provider Details

I. General information

NPI: 1902481401
Provider Name (Legal Business Name): BAO VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 FRESNO ST
FRESNO CA
93721-1722
US

IV. Provider business mailing address

4879 E CESAR CHAVEZ BLVD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-6088
  • Fax:
Mailing address:
  • Phone: 559-722-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number132441
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: