Healthcare Provider Details

I. General information

NPI: 1326685322
Provider Name (Legal Business Name): CA VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DEEP VALLEY DR STE 200
ROLLING HILLS ESTATES CA
90274-3614
US

IV. Provider business mailing address

5538 SHOREVIEW DR
RANCHO PALOS VERDES CA
90275-2226
US

V. Phone/Fax

Practice location:
  • Phone: 310-896-2316
  • Fax:
Mailing address:
  • Phone: 310-408-9839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: