Provider Demographics
NPI:1508930124
Name:CHI HUU PHUNG, M.D., INC
Entity Type:Organization
Organization Name:CHI HUU PHUNG, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHI
Authorized Official - Middle Name:H
Authorized Official - Last Name:PHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-537-8487
Mailing Address - Street 1:13155 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1080
Mailing Address - Country:US
Mailing Address - Phone:714-537-8487
Mailing Address - Fax:714-537-9403
Practice Address - Street 1:13155 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1080
Practice Address - Country:US
Practice Address - Phone:714-537-8487
Practice Address - Fax:714-537-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64118261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641180Medicaid
CAWA64118BMedicare ID - Type Unspecified
CA00A641180Medicaid