Healthcare Provider Details

I. General information

NPI: 1831449065
Provider Name (Legal Business Name): HEU MY VUONG PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE MY VUONG PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 S. HOOVER STREET, 2ND FLOOR
LOS ANGELES CA
90037
US

IV. Provider business mailing address

7568 MOONEY DRIVE
ROSEMEAD CA
91770
US

V. Phone/Fax

Practice location:
  • Phone: 323-541-1600
  • Fax:
Mailing address:
  • Phone: 626-264-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: