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Organization
THAO P PHUNG MD INC
Active
Organization
THAO P PHUNG MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THAO PHUNG M.D. (PRESIDENT)
(310) 483-6256
Entity
Organization
Contact information
Practice address
18035 BROOKHURST ST, FOUNTAIN VALLEY, CA 92708-6738
(310) 483-6256
(562) 232-3728
Mailing address
2913 EL CAMINO REAL STE 316, TUSTIN, CA 92782-8909
(949) 229-1153
(657) 245-3168
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A125932
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A125932
—
CA
Enumeration date
09/05/2018
Last updated
08/31/2023
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