MEDICARE: VAN CHI VONG 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	208D00000X	General Practice Physician	A62976	CA

General Provider Information

NPI Number	:	1427112358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VAN CHI VONG M.D.

Provider Business Mailing Address
First Line	:	625 E VALLEY BLVD STE H
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3591
Country	:	US
Telephone Number	:	626-572-4658
Fax Number	:	626-572-4336

Provider Business Practice Location Address
First Line	:	625 E VALLEY BLVD
Second Line	:	SUITE H
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3591
Country	:	US
Telephone Number	:	626-572-4658
Fax Number	:	626-572-4336

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	03/08/2026

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