Healthcare Provider Details

I. General information

NPI: 1588550289
Provider Name (Legal Business Name): PHUONG WOOD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 SOUTHBROOKE BLVD
FRANKLIN TN
37064-7009
US

IV. Provider business mailing address

21792 SUMMERWIND LN
HUNTINGTON BEACH CA
92646-8264
US

V. Phone/Fax

Practice location:
  • Phone: 310-567-4146
  • Fax:
Mailing address:
  • Phone: 310-567-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number51411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: