Healthcare Provider Details

I. General information

NPI: 1235655499
Provider Name (Legal Business Name): TOMY VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 N HACIENDA BLVD
LA PUENTE CA
91744-1137
US

IV. Provider business mailing address

1647 N HACIENDA BLVD
LA PUENTE CA
91744-1137
US

V. Phone/Fax

Practice location:
  • Phone: 626-850-5318
  • Fax: 626-850-5319
Mailing address:
  • Phone: 626-850-5318
  • Fax: 626-850-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number67622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: