Provider Demographics
NPI:1609515154
Name:KYONO, TRACY VUONG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:VUONG
Last Name:KYONO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 STEVENSON BLVD APT U37
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5853
Mailing Address - Country:US
Mailing Address - Phone:408-888-4381
Mailing Address - Fax:
Practice Address - Street 1:1790 DECOTO RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3524
Practice Address - Country:US
Practice Address - Phone:510-429-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist