Provider Demographics
NPI:1811468176
Name:VUONG, VINH NGHIA
Entity type:Individual
Prefix:
First Name:VINH
Middle Name:NGHIA
Last Name:VUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-9379
Mailing Address - Country:US
Mailing Address - Phone:510-967-2299
Mailing Address - Fax:
Practice Address - Street 1:8298 LANDER AVE
Practice Address - Street 2:
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-8323
Practice Address - Country:US
Practice Address - Phone:209-226-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA79471OtherBOARD OF CALIFORNIA