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1093995813 NPI number — HENRY Q PHUNG D.C.

NPI Number: 1093995813
Health Care Provider/Practitioner: HENRY Q PHUNG D.C.

Information about “1093995813” NPI (HENRY Q PHUNG D.C.) exists in 1093995813 in HTML format HTML  |  1093995813 in plain Text format TXT  |  1093995813 in PDF (Portable Document Format) PDF  |  1093995813 in an XML format XML  formats.

NPI Number : 1093995813 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093995813",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PHUNG",
    "FirstName": "HENRY",
    "MiddleName": "Q",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PHUNG",
    "OtherFirstName": "QUAY",
    "OtherMiddleName": "V",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "7913 CHADWICK LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIVERDALE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30274-6716",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-469-8641",
    "MailingAddressFaxNumber": "678-479-1317",
    "FirstLinePracticeLocationAddress": "7913 CHADWICK LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVERDALE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30274-6716",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-469-8641",
    "PracticeLocationAddressFaxNumber": "678-479-1317",
    "EnumerationDate": "11/08/2007",
    "LastUpdateDate": "11/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "CHIR008288",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "111NR0400X",
          "TaxonomyName": "Rehabilitation Chiropractor",
          "LicenseNumber": "CHIR008288",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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