Provider Demographics
NPI:1578335683
Name:PHUNG, JENNIFER MANH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MANH
Last Name:PHUNG
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 1:1265 WELCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5102
Mailing Address - Country:US
Mailing Address - Phone:650-725-6959
Mailing Address - Fax:650-723-9692
Practice Address - Street 1:8971 NEPTUNE CIR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7751
Practice Address - Country:US
Practice Address - Phone:714-725-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program