Healthcare Provider Details

I. General information

NPI: 1851001069
Provider Name (Legal Business Name): YOUNG VASUA XIONG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 NORWOOD AVE
SACRAMENTO CA
95838-2686
US

IV. Provider business mailing address

4221 NORWOOD AVE
SACRAMENTO CA
95838-2686
US

V. Phone/Fax

Practice location:
  • Phone: 916-614-9502
  • Fax:
Mailing address:
  • Phone: 916-614-9502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: