Healthcare Provider Details

I. General information

NPI: 1366400830
Provider Name (Legal Business Name): VINCENT C HUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 NORTH ALTADENA DR.
PASADENA CA
91107
US

IV. Provider business mailing address

452 NORTH ALTADENA DR.
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 626-432-5032
  • Fax: 626-432-5030
Mailing address:
  • Phone: 626-432-5032
  • Fax: 626-432-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberG40766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: