Healthcare Provider Details

I. General information

NPI: 1578494803
Provider Name (Legal Business Name): VICKY PHUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 16TH ST UNIT 203
SAN FRANCISCO CA
94103-4805
US

IV. Provider business mailing address

588 MISSION BAY BLVD N APT 423
SAN FRANCISCO CA
94158-2489
US

V. Phone/Fax

Practice location:
  • Phone: 415-575-1120
  • Fax:
Mailing address:
  • Phone: 415-696-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: