Provider Demographics
NPI:1689019127
Name:PHUNG, CELYNE THAO (MD)
Entity Type:Individual
Prefix:DR
First Name:CELYNE
Middle Name:THAO
Last Name:PHUNG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1211 W LA PALMA AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2810
Mailing Address - Country:US
Mailing Address - Phone:714-772-8282
Mailing Address - Fax:714-772-6493
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2810
Practice Address - Country:US
Practice Address - Phone:714-772-8282
Practice Address - Fax:714-772-6493
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2021-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA130094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB232047Medicare PIN