Provider Demographics
NPI:1811257413
Name:VANG, KO (LVN)
Entity type:Individual
Prefix:PROF
First Name:KO
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:KO
Other - Middle Name:
Other - Last Name:VANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:5211 E LYELL AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5229
Mailing Address - Country:US
Mailing Address - Phone:559-273-9182
Mailing Address - Fax:
Practice Address - Street 1:5211 E LYELL AVE APT 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-5229
Practice Address - Country:US
Practice Address - Phone:559-273-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN244979164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse