Healthcare Provider Details

I. General information

NPI: 1134225733
Provider Name (Legal Business Name): CHINH MINH VUONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 218TH ST
QUEENS VILLAGE NY
11428-1834
US

IV. Provider business mailing address

9301 218TH ST
QUEENS VILLAGE NY
11428-1834
US

V. Phone/Fax

Practice location:
  • Phone: 718-468-6096
  • Fax: 718-468-6097
Mailing address:
  • Phone: 718-468-6096
  • Fax: 718-468-6097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number172027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: