Healthcare Provider Details

I. General information

NPI: 1124114426
Provider Name (Legal Business Name): LOAN VUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

16886 SW 51ST ST
MIRAMAR FL
33027-4918
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6910
  • Fax:
Mailing address:
  • Phone: 954-442-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0077310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: