Provider Demographics
NPI:1417026840
Name:PHUONG, BRANDON HUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:HUNG
Last Name:PHUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 EL CAMINO REAL STE A
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3169
Mailing Address - Country:US
Mailing Address - Phone:650-595-1906
Mailing Address - Fax:650-595-1905
Practice Address - Street 1:796 EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3169
Practice Address - Country:US
Practice Address - Phone:650-595-1906
Practice Address - Fax:650-595-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist