Healthcare Provider Details

I. General information

NPI: 1679939490
Provider Name (Legal Business Name): LINH VUONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

IV. Provider business mailing address

3021 E PINEFALLS DR
WEST COVINA CA
91792-2954
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-6092
  • Fax:
Mailing address:
  • Phone: 626-260-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95067833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: