Healthcare Provider Details

I. General information

NPI: 1750970901
Provider Name (Legal Business Name): KATHERINE VUONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10892 CARAVELLE PL
SAN DIEGO CA
92124-2039
US

IV. Provider business mailing address

10892 CARAVELLE PL
SAN DIEGO CA
92124-2039
US

V. Phone/Fax

Practice location:
  • Phone: 408-882-7643
  • Fax:
Mailing address:
  • Phone: 408-882-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: