Provider Demographics
NPI:1255878153
Name:VUONG, KALYNN
Entity type:Individual
Prefix:
First Name:KALYNN
Middle Name:
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 1:682 SADDLEBACK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-6002
Mailing Address - Country:US
Mailing Address - Phone:619-501-8046
Mailing Address - Fax:619-501-4997
Practice Address - Street 1:682 SADDLEBACK WAY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-6002
Practice Address - Country:US
Practice Address - Phone:619-501-8046
Practice Address - Fax:619-501-4997
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist