Provider Demographics
NPI:1396082202
Name:VUONG, PHON H (PA)
Entity type:Individual
Prefix:
First Name:PHON
Middle Name:H
Last Name:VUONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31852 COAST HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6764
Mailing Address - Country:US
Mailing Address - Phone:949-499-1389
Mailing Address - Fax:949-499-5689
Practice Address - Street 1:31852 COAST HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6764
Practice Address - Country:US
Practice Address - Phone:949-499-1389
Practice Address - Fax:949-499-5689
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP32182Medicare UPIN