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General NPI Number Information
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NPI Number | 1699886473
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Entity Type | Organization
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Legal Business Name | MINH PHUONG DO, D.M.D. INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12923 INGLEWOOD AVE SUITE 3
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City | HAWTHORNE
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State | CA
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Zip | 90250-5139
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Country | US
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Telephone | 310-679-6464
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Fax | 310-679-6466
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Provider Business Mailing Address
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Address Line | 12923 INGLEWOOD AVE SUITE 3
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City | HAWTHORNE
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State | CA
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Zip | 90250-5139
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Country | US
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Telephone | 310-679-6464
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Fax | 310-679-6466
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MINH PHUONG DO
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Credential | D.M.D.
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Telephone | 310-679-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54411
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License Number State | CA
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