Provider Demographics
NPI:1396929147
Name:VUONG-DAC, MAN (MD)
Entity type:Individual
Prefix:DR
First Name:MAN
Middle Name:
Last Name:VUONG-DAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAN
Other - Middle Name:DAC
Other - Last Name:VUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3649 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3352
Mailing Address - Country:US
Mailing Address - Phone:323-583-6333
Mailing Address - Fax:
Practice Address - Street 1:3649 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3352
Practice Address - Country:US
Practice Address - Phone:323-583-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502431Medicaid
A50243Medicare PIN
F80644Medicare UPIN