MEDICARE: VILAYPHONE THONGSITHAVONG HWANG PNP

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	363L00000X	Nurse Practitioner	009005342	CA

General Provider Information

NPI Number	:	1629060157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VILAYPHONE THONGSITHAVONG HWANG PNP

Provider Business Mailing Address
First Line	:	10833 LE CONTE AVE STE 32-263
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-3075
Country	:	US
Telephone Number	:	310-794-3170
Fax Number	:	310-794-3358

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVE STE 32-263
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-3075
Country	:	US
Telephone Number	:	310-794-3170
Fax Number	:	310-794-3358

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	01/13/2009

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