Healthcare Provider Details

I. General information

NPI: 1942209044
Provider Name (Legal Business Name): MONICA B VUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N 13TH ST
SHELTON WA
98584-2077
US

IV. Provider business mailing address

PO BOX 1668
SHELTON WA
98584-5001
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-2653
  • Fax:
Mailing address:
  • Phone: 360-427-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00044122
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: