Healthcare Provider Details

I. General information

NPI: 1386506780
Provider Name (Legal Business Name): STACY THUYTRANG VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 ZONAL AVE
LOS ANGELES CA
90089-5305
US

IV. Provider business mailing address

1720 S SANTA ANITA AVE
ARCADIA CA
91006-4603
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-1369
  • Fax:
Mailing address:
  • Phone: 626-726-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number49670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: