Provider Demographics
NPI:1164037958
Name:VUONG, EDWARD (DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:VUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 GATEWAY UNIT 3353
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-5851
Mailing Address - Country:US
Mailing Address - Phone:323-698-6801
Mailing Address - Fax:
Practice Address - Street 1:7777 EDINGER AVE STE 232
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-8692
Practice Address - Country:US
Practice Address - Phone:714-312-7714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist