Healthcare Provider Details

I. General information

NPI: 1861758856
Provider Name (Legal Business Name): SHAWN MICHAEL VUONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W 18TH ST STE 100
SIOUX FALLS SD
57104-9890
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-8500
  • Fax: 605-312-8501
Mailing address:
  • Phone: 605-312-8500
  • Fax: 605-312-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number10990
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: