Healthcare Provider Details

I. General information

NPI: 1124577754
Provider Name (Legal Business Name): KHANH HO VUONG MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 ARROYO RD
LIVERMORE CA
94550
US

IV. Provider business mailing address

4951 ARROYO RD
LIVERMORE CA
94550-9650
US

V. Phone/Fax

Practice location:
  • Phone: 925-373-4700
  • Fax:
Mailing address:
  • Phone: 925-373-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number84773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: