Provider Demographics
NPI:1629060157
Name:HWANG, VILAYPHONE THONGSITHAVONG (PNP)
Entity Type:Individual
Prefix:
First Name:VILAYPHONE
Middle Name:THONGSITHAVONG
Last Name:HWANG
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE STE 32-263
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-794-3170
Mailing Address - Fax:310-794-3358
Practice Address - Street 1:10833 LE CONTE AVE STE 32-263
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-794-3170
Practice Address - Fax:310-794-3358
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA009005342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner