Healthcare Provider Details

I. General information

NPI: 1750569885
Provider Name (Legal Business Name): TINH VUONG D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD FL 2
HARBOR CITY CA
90710-2076
US

IV. Provider business mailing address

1403 LOMITA BLVD FL 2
HARBOR CITY CA
90710-2076
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-6203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A10160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: