Healthcare Provider Details

I. General information

NPI: 1164037958
Provider Name (Legal Business Name): EDWARD VUONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 EDINGER AVE STE 232
HUNTINGTON BEACH CA
92647-8692
US

IV. Provider business mailing address

7725 GATEWAY UNIT 3353
IRVINE CA
92618-5851
US

V. Phone/Fax

Practice location:
  • Phone: 714-312-7714
  • Fax:
Mailing address:
  • Phone: 323-698-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: