Provider Demographics
NPI:1164591533
Name:PHUNG, ANH-THU THI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANH-THU
Middle Name:THI
Last Name:PHUNG
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 1:1535 HEATHER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3721
Mailing Address - Country:US
Mailing Address - Phone:626-581-9214
Mailing Address - Fax:
Practice Address - Street 1:10402 WESTMINSTER AVE
Practice Address - Street 2:SUITE 100C
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4861
Practice Address - Country:US
Practice Address - Phone:714-638-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87716208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics