Healthcare Provider Details

I. General information

NPI: 1457791980
Provider Name (Legal Business Name): KHOA DUY VUONG D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

IV. Provider business mailing address

P.O BOX 8700
HARRISBURG PA
17105
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8429
  • Fax:
Mailing address:
  • Phone: 717-231-8429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006505
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: