Provider Demographics
NPI:1669584181
Name:VUONG, THOMAS THANH (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:THANH
Last Name:VUONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 W OAKLAWN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4300
Mailing Address - Country:US
Mailing Address - Phone:830-569-3553
Mailing Address - Fax:830-569-3787
Practice Address - Street 1:1240 W OAKLAWN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4300
Practice Address - Country:US
Practice Address - Phone:830-569-3553
Practice Address - Fax:830-569-3787
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BV8160056OtherDEA
TX8F9414Medicare PIN
H79492Medicare UPIN