Healthcare Provider Details

I. General information

NPI: 1285924217
Provider Name (Legal Business Name): TAM TRI VUONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1000
  • Fax:
Mailing address:
  • Phone: 360-487-1000
  • Fax:

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 StateOR
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60455593
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: