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General NPI Number Information
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NPI Number | 1568467140
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Entity Type | Individual
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Provider Name | CHI HUU PHUNG MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2514 E. ALKI PL
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City | ANAHEIM
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State | CA
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Zip | 92806-5002
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Country | US
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Telephone | 714-817-8455
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Fax | 714-537-9403
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Provider Business Mailing Address
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Address Line | 2514 E ALKI PL
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City | ANAHEIM
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State | CA
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Zip | 92806-5002
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Country | US
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Telephone | 714-817-8455
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Fax | 714-537-9403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A64118B
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License Number State | CA
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