Healthcare Provider Details

I. General information

NPI: 1861594459
Provider Name (Legal Business Name): BILL NHUNG Q VUONG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 16TH AVE SUITE 116 GENUINE PODIATRY SERVICES
DAYTON TN
37321
US

IV. Provider business mailing address

1604 RAMSGATE PKWY
HIXSON TN
37343-2561
US

V. Phone/Fax

Practice location:
  • Phone: 423-775-5400
  • Fax: 423-570-0222
Mailing address:
  • Phone: 423-843-9938
  • Fax: 423-843-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberTN00598
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: