Healthcare Provider Details

I. General information

NPI: 1285058313
Provider Name (Legal Business Name): TIEU-DIEN VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 SEPULVEDA BLVD
TORRANCE CA
90505-2606
US

IV. Provider business mailing address

3455 SEPULVEDA BLVD
TORRANCE CA
90505-2606
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-0535
  • Fax: 310-371-2510
Mailing address:
  • Phone: 310-370-0535
  • Fax: 310-371-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number56526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: