Provider Demographics
NPI:1063934180
Name:PHUNG, Y DAU NHU (OD)
Entity type:Individual
Prefix:DR
First Name:Y DAU NHU
Middle Name:
Last Name:PHUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NHU Y
Other - Middle Name:
Other - Last Name:PHUNG DAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:11704 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2434
Mailing Address - Country:US
Mailing Address - Phone:312-806-6018
Mailing Address - Fax:
Practice Address - Street 1:1020 WILLOWBROOK MALL # 1020
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5788
Practice Address - Country:US
Practice Address - Phone:281-894-5300
Practice Address - Fax:281-894-5393
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9893T152W00000X
NYTUV008650-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist