Healthcare Provider Details

I. General information

NPI: 1164591533
Provider Name (Legal Business Name): ANH-THU THI PHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10402 WESTMINSTER AVE SUITE 100C
GARDEN GROVE CA
92843-4861
US

IV. Provider business mailing address

1535 HEATHER HILL RD
HACIENDA HEIGHTS CA
91745-3721
US

V. Phone/Fax

Practice location:
  • Phone: 714-638-1358
  • Fax:
Mailing address:
  • Phone: 626-581-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA87716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: