Provider Demographics
NPI:1699819813
Name:VUONG, JAY (DDS)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:VUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LONG
Other - Middle Name:NGOC
Other - Last Name:VUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:630 1ST AVE APT 6R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3786
Mailing Address - Country:US
Mailing Address - Phone:212-684-6399
Mailing Address - Fax:
Practice Address - Street 1:630 1ST AVE APT 6R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3786
Practice Address - Country:US
Practice Address - Phone:212-684-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0487041223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics