MEDICARE: DR. BRANDON HUNG PHUONG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	46672	CA

General Provider Information

NPI Number	:	1417026840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON HUNG PHUONG DMD

Provider Business Mailing Address
First Line	:	796 EL CAMINO REAL STE A
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-3169
Country	:	US
Telephone Number	:	650-595-1906
Fax Number	:	650-595-1905

Provider Business Practice Location Address
First Line	:	796 EL CAMINO REAL STE A
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-3169
Country	:	US
Telephone Number	:	650-595-1906
Fax Number	:	650-595-1905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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