Individual
DR. MARY JENNIFER YAO ONG PHUONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5734 COVENTRY LN, FORT WAYNE, IN 46804-7141
(260) 436-8775
(260) 432-9812
Mailing address
2121 LAKE AVE, OPERATING ROOM - THIRD FLOOR, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 460-1383
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01057246
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200445020
—
IN
Enumeration date
05/16/2006
Last updated
11/04/2014
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