Provider Demographics
NPI:1962726125
Name:VUONG, DIANA BACH VAN (LAC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:BACH VAN
Last Name:VUONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 MONTGOMERY STREET
Mailing Address - Street 2:SUITE 1084
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104
Mailing Address - Country:US
Mailing Address - Phone:415-395-9955
Mailing Address - Fax:415-395-9125
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:SUITE 1084
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-395-9955
Practice Address - Fax:415-395-9125
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist