Individual
TIN VUONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
703 S AMERICANA BLVD STE 120, BOISE, ID 83702-6754
(208) 706-9340
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
O-1471
ID
Other
Enumeration date
03/29/2012
Last updated
09/16/2021
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