MEDICARE: TOU CHOUA VANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A83557	CA
2	208D00000X	General Practice Physician	A83557	CA

General Provider Information

NPI Number	:	1053401927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOU CHOUA VANG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 883
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93613-0883
Country	:	US
Telephone Number	:	559-890-6111
Fax Number	:	559-892-0327

Provider Business Practice Location Address
First Line	:	3727 N 1ST ST STE 106
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-5628
Country	:	US
Telephone Number	:	559-890-6111
Fax Number	:	559-892-0327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	01/06/2025

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