Provider Demographics
NPI:1649203910
Name:LANH M. PHUNG, M.D. INC.
Entity Type:Organization
Organization Name:LANH M. PHUNG, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANH
Authorized Official - Middle Name:MANH
Authorized Official - Last Name:PHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-766-6503
Mailing Address - Street 1:10130 WARNER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1619
Mailing Address - Country:US
Mailing Address - Phone:714-766-6503
Mailing Address - Fax:714-766-6505
Practice Address - Street 1:10130 WARNER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1619
Practice Address - Country:US
Practice Address - Phone:714-766-6503
Practice Address - Fax:714-766-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48978207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489780Medicaid
CAF73580Medicare UPIN
CAW22098Medicare PIN