Provider Demographics
NPI:1578921615
Name:PHUNG, NGOC LENA (RPH)
Entity Type:Individual
Prefix:MS
First Name:NGOC LENA
Middle Name:
Last Name:PHUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 GIOTTO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8577
Mailing Address - Country:US
Mailing Address - Phone:714-417-0661
Mailing Address - Fax:
Practice Address - Street 1:477 GIOTTO
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-8577
Practice Address - Country:US
Practice Address - Phone:714-417-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist