Provider Demographics
NPI:1891980017
Name:PHAN, HUONG THIEN (MD)
Entity type:Individual
Prefix:
First Name:HUONG
Middle Name:THIEN
Last Name:PHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 UPTOWN BOULEVARD
Mailing Address - Street 2:100
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3505
Mailing Address - Country:US
Mailing Address - Phone:972-293-3569
Mailing Address - Fax:
Practice Address - Street 1:294 UPTOWN BOULEVARD
Practice Address - Street 2:100
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3505
Practice Address - Country:US
Practice Address - Phone:972-293-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AA836OtherBCBS
TX8AA836OtherBCBS