Provider Demographics
NPI:1114662970
Name:HUSSAIN, PHUONG LINH (FNP)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:LINH
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:LINH
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:517 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3740
Mailing Address - Country:US
Mailing Address - Phone:714-808-2404
Mailing Address - Fax:
Practice Address - Street 1:4816 E 3RD ST
Practice Address - Street 2:
Practice Address - City:EAST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1602
Practice Address - Country:US
Practice Address - Phone:323-780-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN61003817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily