Healthcare Provider Details

I. General information

NPI: 1801729967
Provider Name (Legal Business Name): MIMI VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1740
US

IV. Provider business mailing address

9309 CLINTON ANDERSON DR NW
ALBUQUERQUE NM
87114-5346
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2111
  • Fax:
Mailing address:
  • Phone: 505-974-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: