Individual
LOI K PHUONG
Active
Individual
LOI K PHUONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
01057259A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140008277
RR MEDICARE
IN
05
—
200420740
—
IN
05
—
2382103
—
OH
05
—
4657102
—
MI
01
—
IN4866034
MEDICARE PTAN
IN
Enumeration date
07/01/2005
Last updated
01/04/2024
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