Healthcare Provider Details

I. General information

NPI: 1386229060
Provider Name (Legal Business Name): MICHAEL CHI DONG VUONG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 GARRISONVILLE RD
STAFFORD VA
22554-3907
US

IV. Provider business mailing address

3907 FAIRFAX PKWY
ALEXANDRIA VA
22312-1147
US

V. Phone/Fax

Practice location:
  • Phone: 540-318-6464
  • Fax:
Mailing address:
  • Phone: 703-798-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007759
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: