Provider Demographics
NPI:1073677852
Name:VOVAN, LAURA DOAN PHUONG (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DOAN PHUONG
Last Name:VOVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18698 STRATTON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-7017
Mailing Address - Country:US
Mailing Address - Phone:310-400-9900
Mailing Address - Fax:714-531-5824
Practice Address - Street 1:600 83RD ST
Practice Address - Street 2:#2
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-1335
Practice Address - Country:US
Practice Address - Phone:917-727-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72334OtherSTATE LICENSE
NY260451OtherSTATE LICENSE
FLME110678OtherSTATE LICENSE