Healthcare Provider Details

I. General information

NPI: 1619190733
Provider Name (Legal Business Name): VAN H VUONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34700 11TH PLACE SOUTH
FEDERAL WAY WA
98003
US

IV. Provider business mailing address

34700 11TH PLACE SOUTH
FEDERAL WAY WA
98003
US

V. Phone/Fax

Practice location:
  • Phone: 253-946-9900
  • Fax: 253-946-1353
Mailing address:
  • Phone: 253-946-9900
  • Fax: 253-946-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE8694
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: