Provider Demographics
NPI:1831764463
Name:VANG, SONNY (BS)
Entity type:Individual
Prefix:
First Name:SONNY
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 CORMORANT DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-2539
Mailing Address - Country:US
Mailing Address - Phone:707-563-4453
Mailing Address - Fax:
Practice Address - Street 1:2656 EL PRADO WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0304
Practice Address - Country:US
Practice Address - Phone:916-800-2872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician