Healthcare Provider Details

I. General information

NPI: 1588868178
Provider Name (Legal Business Name): PHONG PHAT TANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SUNSET BLVD
HOUSTON TX
77005-1713
US

IV. Provider business mailing address

PO BOX 4767
HOUSTON TX
77210-4767
US

V. Phone/Fax

Practice location:
  • Phone: 713-526-5511
  • Fax: 713-520-4755
Mailing address:
  • Phone: 713-520-4714
  • Fax: 713-520-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN3339
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN3339
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: