Basic Information
| Provider Information | |||||||||
| NPI: | 1073804779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VONG | ||||||||
| FirstName: | SHEUNG | ||||||||
| MiddleName: | KAI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10418 VALLEY BLVD | ||||||||
| Address2: | STE. B | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917313600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264538466 | ||||||||
| FaxNumber: | 6264538456 | ||||||||
| Practice Location | |||||||||
| Address1: | 10418 VALLEY BLVD | ||||||||
| Address2: | STE B | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917313600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264538466 | ||||||||
| FaxNumber: | 6264538456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2011 | ||||||||
| LastUpdateDate: | 09/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A12775 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.