Provider Demographics
NPI:1558817056
Name:NGUYEN, PHUNG
Entity Type:Individual
Prefix:MS
First Name:PHUNG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 SW 89TH ST APT 15103
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7951
Mailing Address - Country:US
Mailing Address - Phone:858-859-5145
Mailing Address - Fax:
Practice Address - Street 1:3131 SW 89TH ST APT 15103
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7951
Practice Address - Country:US
Practice Address - Phone:858-859-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator