Healthcare Provider Details

I. General information

NPI: 1124722533
Provider Name (Legal Business Name): CONNOR VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ STE 7501
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLZ STE 7501
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-9643
  • Fax:
Mailing address:
  • Phone: 480-586-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA209371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: