Provider Demographics
NPI:1396205092
Name:VUONG-DAC, MAI-ANH
Entity Type:Individual
Prefix:
First Name:MAI-ANH
Middle Name:
Last Name:VUONG-DAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 WHITTIER BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2338
Mailing Address - Country:US
Mailing Address - Phone:562-947-1669
Mailing Address - Fax:562-464-5134
Practice Address - Street 1:15725 WHITTIER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2338
Practice Address - Country:US
Practice Address - Phone:562-947-1669
Practice Address - Fax:562-464-5134
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA179403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine