Healthcare Provider Details

I. General information

NPI: 1396527727
Provider Name (Legal Business Name): MANDY HUYNH VUONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7812 WARNER AVE
HUNTINGTON BEACH CA
92647-4700
US

IV. Provider business mailing address

152 PATTERN
IRVINE CA
92618-1411
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-3222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: