Provider Demographics
NPI:1669745782
Name:VUONG, THIEN KIM NGUYEN (OD)
Entity type:Individual
Prefix:DR
First Name:THIEN KIM
Middle Name:NGUYEN
Last Name:VUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:THIEN KIM
Other - Middle Name:TRAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4280 EAST WEST CONNECTOR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4804
Mailing Address - Country:US
Mailing Address - Phone:559-486-2000
Mailing Address - Fax:559-256-8575
Practice Address - Street 1:7075 N SHARON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3329
Practice Address - Country:US
Practice Address - Phone:559-486-2000
Practice Address - Fax:559-256-8575
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1826152W00000X
GA003273152W00000X
CA15154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1826OtherAZ STATE BOARD OF OPTOMETRY