Provider Demographics
NPI:1558639054
Name:HOANG, PHUNG KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUNG
Middle Name:KIM
Last Name:HOANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:P K
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:30 E 40TH ST
Mailing Address - Street 2:SUITE 1203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1201
Mailing Address - Country:US
Mailing Address - Phone:212-684-6759
Mailing Address - Fax:212-684-6758
Practice Address - Street 1:30 E 40TH ST
Practice Address - Street 2:SUITE 1203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1201
Practice Address - Country:US
Practice Address - Phone:212-684-6759
Practice Address - Fax:212-684-6758
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0451071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics