Healthcare Provider Details

I. General information

NPI: 1962306621
Provider Name (Legal Business Name): PAUL VUONG DO A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22870 NAVUT AVE
WILDOMAR CA
92595-9512
US

IV. Provider business mailing address

22870 NAVUT AVE
WILDOMAR CA
92595-9512
US

V. Phone/Fax

Practice location:
  • Phone: 408-605-7151
  • Fax: 714-639-7828
Mailing address:
  • Phone: 408-605-7151
  • Fax: 714-639-7828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAUL VUONG
Title or Position: OWNER
Credential: DO
Phone: 408-605-7151