Provider Demographics
NPI:1114535333
Name:WOUNDYNAMICS LLC
Entity Type:Organization
Organization Name:WOUNDYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:DANH
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-225-1122
Mailing Address - Street 1:1601 SW 89TH ST STE A100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6357
Mailing Address - Country:US
Mailing Address - Phone:206-465-4313
Mailing Address - Fax:405-225-1593
Practice Address - Street 1:1601 SW 89TH ST STE A100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6357
Practice Address - Country:US
Practice Address - Phone:206-465-4313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty