Healthcare Provider Details

I. General information

NPI: 1356443485
Provider Name (Legal Business Name): HUY Q PHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 OLIVEHURST AVE
OLIVEHURST CA
95961-4225
US

IV. Provider business mailing address

PO BOX AD PROVIDER CREDENTIALING
YUBA CITY CA
95992-1396
US

V. Phone/Fax

Practice location:
  • Phone: 530-743-4611
  • Fax: 530-743-5770
Mailing address:
  • Phone: 530-751-3769
  • Fax: 530-751-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA83987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: