Provider Demographics
NPI:1124290390
Name:PHUNG, VU ANH (MD)
Entity type:Individual
Prefix:DR
First Name:VU
Middle Name:ANH
Last Name:PHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16611 CHAMPAGNE FALLS CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5075
Mailing Address - Country:US
Mailing Address - Phone:614-477-1006
Mailing Address - Fax:
Practice Address - Street 1:6022 FM 1488 RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2542
Practice Address - Country:US
Practice Address - Phone:281-583-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00740142OtherMEDICARE RR#
8L15723OtherMEDICARE PTAN
TXP00740142OtherMEDICARE RR#
8L15723OtherMEDICARE PTAN