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Individual

THETHONG P THEPVONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
EMT

Contact information

Practice address
900 W BELGRAVIA AVE, FRESNO, CA 93706-3909
(559) 265-2045
Mailing address
1115 E GOSHEN AVE, FRESNO, CA 93720-2621
(559) 259-0994

Taxonomy

Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
E119251
CA

Other

Enumeration date
10/21/2020
Last updated
10/21/2020
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