Healthcare Provider Details

I. General information

NPI: 1609614700
Provider Name (Legal Business Name): GALEN GIANG VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 SILVER CREEK VALLEY PLACE
SAN JOSE CA
95138
US

IV. Provider business mailing address

5855 SILVER CREEK VALLEY PLACE
SAN JOSE CA
95138
US

V. Phone/Fax

Practice location:
  • Phone: 408-574-9252
  • Fax: 408-574-9236
Mailing address:
  • Phone: 408-574-9252
  • Fax: 408-574-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95192042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: