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General NPI Number Information
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NPI Number | 1033142278
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Entity Type | Organization
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Legal Business Name | SAN BERNARDINO WOMEN'S HEALTH MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 5365 WALNUT AVE SUITE A
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City | CHINO
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State | CA
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Zip | 91710-2622
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Country | US
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Telephone | 909-591-1743
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Fax | 909-591-1744
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Provider Business Mailing Address
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Address Line | 5365 WALNUT AVE SUITE A
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City | CHINO
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State | CA
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Zip | 91710-2622
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Country | US
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Telephone | 909-591-1743
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Fax | 909-591-1744
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DUONG THIEU PHUNG
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Credential | M.D.
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Telephone | 909-591-1743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A70551
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License Number State | CA
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