Provider Demographics
NPI:1598077869
Name:DONG, PHUC SON SI (DO)
Entity Type:Individual
Prefix:DR
First Name:PHUC
Middle Name:SON SI
Last Name:DONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3980 DOUGLAS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4263
Practice Address - Country:US
Practice Address - Phone:916-293-4400
Practice Address - Fax:916-293-4401
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A12891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine