Provider Demographics
NPI:1699909622
Name:PHUNG, THAO P (MD)
Entity type:Individual
Prefix:
First Name:THAO
Middle Name:P
Last Name:PHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2913 EL CAMINO REAL STE 316
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8909
Mailing Address - Country:US
Mailing Address - Phone:949-229-1153
Mailing Address - Fax:657-245-3168
Practice Address - Street 1:2913 EL CAMINO REAL STE 316
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-8909
Practice Address - Country:US
Practice Address - Phone:949-229-1153
Practice Address - Fax:657-245-3168
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA125932207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine