Provider Demographics
NPI:1003270562
Name:DO, PHONG HOANG (MD)
Entity Type:Individual
Prefix:
First Name:PHONG
Middle Name:HOANG
Last Name:DO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:470 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-2648
Mailing Address - Country:US
Mailing Address - Phone:631-329-5900
Mailing Address - Fax:
Practice Address - Street 1:4441 ATLANTA RD SE STE 107
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:470-956-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310904207Q00000X
GA83030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine