=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013497734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VOONG CHUANG LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2018
-----------------------------------------------------
Last Update Date | 09/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 LOS GATOS SARATOGA RD
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95030-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-786-7677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1030 PENNINGTON LN
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-4930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-786-7677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | DAVID CHUANG
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 408-786-7677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number | E5438
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------