Healthcare Provider Details

I. General information

NPI: 1477231058
Provider Name (Legal Business Name): LEON VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12966 EUCLID ST STE 495
GARDEN GROVE CA
92840-9209
US

IV. Provider business mailing address

12966 EUCLID ST STE 495
GARDEN GROVE CA
92840-9209
US

V. Phone/Fax

Practice location:
  • Phone: 714-461-3687
  • Fax: 714-591-5015
Mailing address:
  • Phone: 714-936-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: