Healthcare Provider Details

I. General information

NPI: 1912645227
Provider Name (Legal Business Name): FAUSTINE CHANG VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRAVEN RD
SAN MARCOS CA
92078-4201
US

IV. Provider business mailing address

9801 SYDNEY LN APT 60346
SAN DIEGO CA
92126-8218
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL7089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: