Healthcare Provider Details

I. General information

NPI: 1255448957
Provider Name (Legal Business Name): KEVIN HIEU VUONG NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEVIN HIEU VUONG NP

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 FLORIN RD
SACRAMENTO CA
95831-3515
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-5142
  • Fax: 916-424-4655
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 14307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: