Healthcare Provider Details

I. General information

NPI: 1699819813
Provider Name (Legal Business Name): JAY VUONG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LONG NGOC VUONG

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 1ST AVE APT 6R
NEW YORK NY
10016-3786
US

IV. Provider business mailing address

630 1ST AVE APT 6R
NEW YORK NY
10016-3786
US

V. Phone/Fax

Practice location:
  • Phone: 212-684-6399
  • Fax:
Mailing address:
  • Phone: 212-684-6399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number048704
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: