Provider Demographics
NPI:1255448957
Name:VUONG, KEVIN HIEU (NP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:HIEU
Last Name:VUONG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:PROF
Other - First Name:KEVIN
Other - Middle Name:HIEU
Other - Last Name:VUONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:980 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3515
Practice Address - Country:US
Practice Address - Phone:916-453-5142
Practice Address - Fax:916-424-4655
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 14307363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAV435ZMedicare PIN