Healthcare Provider Details

I. General information

NPI: 1356979355
Provider Name (Legal Business Name): AIDAN XUONG VUONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4404
US

IV. Provider business mailing address

1441 FLORIDA AVE
MODESTO CA
95350-4404
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-3525
  • Fax:
Mailing address:
  • Phone: 209-576-3525
  • Fax: 209-576-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: