Provider Demographics
NPI:1720563091
Name:PHUNG, TOAN HON
Entity Type:Individual
Prefix:
First Name:TOAN
Middle Name:HON
Last Name:PHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-3745
Mailing Address - Country:US
Mailing Address - Phone:415-867-0201
Mailing Address - Fax:
Practice Address - Street 1:225 TEXAS ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-3745
Practice Address - Country:US
Practice Address - Phone:415-867-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst