Healthcare Provider Details

I. General information

NPI: 1609861483
Provider Name (Legal Business Name): JOANNA TUYET VUONG D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

10301 BOLSA AVE SUITE 206
WESTMINSTER CA
92683-6784
US

IV. Provider business mailing address

10301 BOLSA AVE SUITE 206
WESTMINSTER CA
92683-6784
US

V. Phone/Fax

Practice location:
  • Phone: 714-531-5895
  • Fax:
Mailing address:
  • Phone: 714-531-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number37514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: