Healthcare Provider Details

I. General information

NPI: 1154931418
Provider Name (Legal Business Name): ANDREW VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17111 BEACH BLVD STE 205
HUNTINGTON BEACH CA
92647-5947
US

IV. Provider business mailing address

3217 CARSON ST # 205
LAKEWOOD CA
90712-4006
US

V. Phone/Fax

Practice location:
  • Phone: 714-654-1570
  • Fax:
Mailing address:
  • Phone: 562-310-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: