Provider Demographics
NPI:1659778405
Name:VANG, PAO GE
Entity Type:Individual
Prefix:
First Name:PAO
Middle Name:GE
Last Name:VANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5003
Mailing Address - Country:US
Mailing Address - Phone:916-338-1001
Mailing Address - Fax:916-338-1044
Practice Address - Street 1:5240 JACKSON ST
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5003
Practice Address - Country:US
Practice Address - Phone:916-338-1001
Practice Address - Fax:916-338-1044
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical