Individual
AIVI DOLAN PHUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6973 LINDA VISTA RD, SAN DIEGO, CA 92111-6342
(858) 279-0925
Mailing address
6973 LINDA VISTA RD, SAN DIEGO, CA 92111-6342
(858) 279-0925
(858) 633-4680
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA53902
CA
Other
Enumeration date
06/06/2016
Last updated
12/22/2023
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