Healthcare Provider Details

I. General information

NPI: 1518691054
Provider Name (Legal Business Name): THUONG VO MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14360 BROOKHURST ST
GARDEN GROVE CA
92843-4608
US

IV. Provider business mailing address

43821 15TH ST W
LANCASTER CA
93534-4756
US

V. Phone/Fax

Practice location:
  • Phone: 714-333-8312
  • Fax: 714-509-1751
Mailing address:
  • Phone: 714-509-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THUONG D VO
Title or Position: PRESIDENT
Credential: MD
Phone: 714-234-5826