Provider Demographics
NPI:1386229060
Name:VUONG, MICHAEL CHI DONG (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHI DONG
Last Name:VUONG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 FAIRFAX PKWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1147
Mailing Address - Country:US
Mailing Address - Phone:703-798-4109
Mailing Address - Fax:
Practice Address - Street 1:882 GARRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3907
Practice Address - Country:US
Practice Address - Phone:540-318-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017745910001Medicaid
VA1386229060Medicaid
VA30017745910002Medicaid