Provider Demographics
NPI:1033142278
Name:SAN BERNARDINO WOMEN'S HEALTH MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SAN BERNARDINO WOMEN'S HEALTH MEDICAL GROUP, INC.
Other - Org Name:NA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUONG
Authorized Official - Middle Name:THIEU
Authorized Official - Last Name:PHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-591-1743
Mailing Address - Street 1:5365 WALNUT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2622
Mailing Address - Country:US
Mailing Address - Phone:909-591-1743
Mailing Address - Fax:909-591-1744
Practice Address - Street 1:5365 WALNUT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2622
Practice Address - Country:US
Practice Address - Phone:909-591-1743
Practice Address - Fax:909-591-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty