Provider Demographics
NPI:1669924338
Name:VANG, UDOM (PHARMD)
Entity type:Individual
Prefix:
First Name:UDOM
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 CREST DR
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3187
Mailing Address - Country:US
Mailing Address - Phone:530-616-1453
Mailing Address - Fax:
Practice Address - Street 1:136 BRYDEN WAY
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-8031
Practice Address - Country:US
Practice Address - Phone:530-616-1453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist