Healthcare Provider Details

I. General information

NPI: 1164637682
Provider Name (Legal Business Name): CUONG T. VUONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

9612 WOLF CREEK DR
IRVING TX
75063-5020
US

V. Phone/Fax

Practice location:
  • Phone: 408-786-6575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT187845
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA110513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: