Healthcare Provider Details

I. General information

NPI: 1154357556
Provider Name (Legal Business Name): SUNYE KWACK VUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNYE KWACK M.D.

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MERCED ST
SAN LEANDRO CA
94577-4201
US

IV. Provider business mailing address

2500 MERCED ST
SAN LEANDRO CA
94577-4201
US

V. Phone/Fax

Practice location:
  • Phone: 510-454-1000
  • Fax:
Mailing address:
  • Phone: 510-454-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA68036
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA68036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: