MEDICARE: CHI HUU PHUNG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A64118B	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568467140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHI HUU PHUNG MD

Provider Business Mailing Address
First Line	:	2514 E ALKI PL
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-5002
Country	:	US
Telephone Number	:	714-817-8455
Fax Number	:	714-537-9403

Provider Business Practice Location Address
First Line	:	2514 E. ALKI PL
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-5002
Country	:	US
Telephone Number	:	714-817-8455
Fax Number	:	714-537-9403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/09/2007

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