Provider Demographics
NPI:1972065340
Name:VUONG, HUAN KHA
Entity Type:Individual
Prefix:
First Name:HUAN
Middle Name:KHA
Last Name:VUONG
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 1:990 S HIGHWAY 395
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2699
Mailing Address - Country:US
Mailing Address - Phone:541-564-1285
Mailing Address - Fax:
Practice Address - Street 1:990 S HIGHWAY 395
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2699
Practice Address - Country:US
Practice Address - Phone:541-564-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0017031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist