Healthcare Provider Details

I. General information

NPI: 1497405344
Provider Name (Legal Business Name): HAN PHAM HULEN, MD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8648 MEDICAL CITY WAY
FORT WORTH TX
76177-2413
US

IV. Provider business mailing address

PO BOX 3409
PFLUGERVILLE TX
78691-3409
US

V. Phone/Fax

Practice location:
  • Phone: 512-202-3830
  • Fax: 512-354-1106
Mailing address:
  • Phone: 513-252-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HAN PHAM HULEN
Title or Position: CEO
Credential:
Phone: 214-274-1507