Healthcare Provider Details

I. General information

NPI: 1396280871
Provider Name (Legal Business Name): BAO VUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FESTIVO
IRVINE CA
92606-8906
US

IV. Provider business mailing address

11 FESTIVO
IRVINE CA
92606-8906
US

V. Phone/Fax

Practice location:
  • Phone: 714-230-5336
  • Fax:
Mailing address:
  • Phone: 714-230-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number64503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: