Provider Demographics
NPI:1215968441
Name:DO, MINH PHUONG (DMD)
Entity type:Individual
Prefix:DR
First Name:MINH
Middle Name:PHUONG
Last Name:DO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MINH
Other - Middle Name:PHUONG
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:15725 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2651
Mailing Address - Country:US
Mailing Address - Phone:310-676-6464
Mailing Address - Fax:310-676-6465
Practice Address - Street 1:15725 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2651
Practice Address - Country:US
Practice Address - Phone:310-676-6464
Practice Address - Fax:310-676-6465
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice