Provider Demographics
NPI:1548004633
Name:VUONG, CALVIN (PA-C)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:VUONG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 BRIGHTON PL
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-1413
Mailing Address - Country:US
Mailing Address - Phone:504-376-7498
Mailing Address - Fax:
Practice Address - Street 1:1905 BRIGHTON PL
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-1413
Practice Address - Country:US
Practice Address - Phone:504-376-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant