Individual
AUSTIN VANNATH PLONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2661 E FLORENCE AVE, SUITE D-1, HUNTINGTON PARK, CA 90255-4793
(323) 588-6113
(323) 588-6468
Mailing address
2661 E FLORENCE AVE, SUITE D-1, HUNTINGTON PARK, CA 90255-4793
(323) 588-6113
(323) 588-6468
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15560
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0100930
—
CA
Enumeration date
11/06/2007
Last updated
11/06/2007
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