| Thao P Phung MD Inc | |
|
18035 Brookhurst St Fountain Valley CA 92708-6738 | |
| (310) 483-6256 | |
| (562) 232-3728 |
| Full Name | Thao P Phung MD Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 18035 Brookhurst St, Fountain Valley, California |
| Authorized Official Name and Position | Thao Phung (PRESIDENT) |
| Authorized Official Contact | 3104836256 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thao P Phung MD Inc 2913 El Camino Real Ste 316 Tustin CA 92782-8909 Ph: (949) 229-1153 | Thao P Phung MD Inc 18035 Brookhurst St Fountain Valley CA 92708-6738 Ph: (310) 483-6256 |
| NPI Number | 1043792112 |
|---|---|
| Provider Enumeration Date | 09/05/2018 |
| Last Update Date | 08/31/2023 |
| Certification Date | 08/31/2023 |
| Medicare PECOS PAC ID | 5799037818 |
|---|---|
| Medicare Enrollment ID | O20181017002305 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043792112 | NPI | - | NPPES |
| A125932 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A125932 (California) | Primary |
| Provider Name | Thao P Phung |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699909622 PECOS PAC ID: 2567742109 Enrollment ID: I20161216001593 |
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