Individual
JENNIFER THUY HO PHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2545 W HAMMER LN, STOCKTON, CA 95209-2839
(209) 957-7050
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A107567
CA
207V00000X
Obstetrics & Gynecology Physician
Primary
A107567
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A1075670
—
CA
01
—
1386636165
GROUP NPI
CA
01
—
68-0277719
GROUP TAX ID
CA
Enumeration date
07/02/2008
Last updated
09/23/2016
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