Healthcare Provider Details

I. General information

NPI: 1114700226
Provider Name (Legal Business Name): KHOA DANG VUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 ATLANTIC AVE
LONG BEACH CA
90805-3013
US

IV. Provider business mailing address

14304 SUMMERWOOD DR
WESTMINSTER CA
92683-1400
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-2821
  • Fax:
Mailing address:
  • Phone: 714-548-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: