Healthcare Provider Details

I. General information

NPI: 1730794066
Provider Name (Legal Business Name): KEVIN TRONG PHUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 EASTCHESTER DR
HIGH POINT NC
27265-1488
US

IV. Provider business mailing address

793 AVALON SPRINGS CT
HIGH POINT NC
27265-2914
US

V. Phone/Fax

Practice location:
  • Phone: 336-889-9916
  • Fax:
Mailing address:
  • Phone: 337-281-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11999
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: