Healthcare Provider Details

I. General information

NPI: 1679617765
Provider Name (Legal Business Name): LARRY VUONG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 W COMMONWEALTH AVE
FULLERTON CA
92833-2724
US

IV. Provider business mailing address

1324 W COMMONWEALTH AVE
FULLERTON CA
92833-2724
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-0200
  • Fax: 714-451-8974
Mailing address:
  • Phone: 714-446-0200
  • Fax: 714-451-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: