Individual
QUANG PHUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
6427 LARGE ST, PHILADELPHIA, PA 19149-2747
(619) 677-4304
Mailing address
6427 LARGE ST, PHILADELPHIA, PA 19149-2747
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP031416
PA
Other
Enumeration date
11/22/2024
Last updated
11/22/2024
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