Provider Demographics
NPI:1609433689
Name:PHUNG, QUAN HOANG (MD)
Entity Type:Individual
Prefix:
First Name:QUAN
Middle Name:HOANG
Last Name:PHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE # 480
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-626-0400
Mailing Address - Fax:612-625-6919
Practice Address - Street 1:420 DELAWARE ST SE # 480
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-626-0400
Practice Address - Fax:612-625-6919
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP04596207R00000X
MN75066207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine