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General NPI Number Information
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NPI Number | 1740445154
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Entity Type | Individual
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Provider Name | PHUONG Q TIEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 14120 BEACH BLVD STE 180
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City | WESTMINSTER
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State | CA
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Zip | 92683-4454
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Country | US
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Telephone | 714-333-3333
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Fax | 714-891-3234
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Provider Business Mailing Address
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Address Line | 14120 BEACH BLVD STE 180
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City | WESTMINSTER
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State | CA
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Zip | 92683-4454
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Country | US
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Telephone | 714-333-3333
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Fax | 714-891-3234
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A111842
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A111842
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License Number State | CA
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