Provider Demographics
NPI:1053401927
Name:VANG, TOU CHOUA (MD)
Entity type:Individual
Prefix:
First Name:TOU
Middle Name:CHOUA
Last Name:VANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93613-0883
Mailing Address - Country:US
Mailing Address - Phone:559-890-6111
Mailing Address - Fax:559-892-0327
Practice Address - Street 1:3727 N 1ST ST STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5628
Practice Address - Country:US
Practice Address - Phone:559-890-6111
Practice Address - Fax:559-892-0327
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83557208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H91796Medicare UPIN