Provider Demographics
NPI:1124109780
Name:HA, PHUNG VO (MD)
Entity type:Individual
Prefix:MRS
First Name:PHUNG
Middle Name:VO
Last Name:HA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5025 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-5407
Mailing Address - Country:US
Mailing Address - Phone:916-736-9639
Mailing Address - Fax:916-731-5660
Practice Address - Street 1:5025 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-5407
Practice Address - Country:US
Practice Address - Phone:916-736-9639
Practice Address - Fax:916-731-5660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41020302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29237Medicare UPIN