Provider Demographics
NPI:1912013780
Name:PHAN, DUNG MY (MD)
Entity Type:Individual
Prefix:MRS
First Name:DUNG
Middle Name:MY
Last Name:PHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1693 FLANIGAN DR
Mailing Address - Street 2:#100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121
Mailing Address - Country:US
Mailing Address - Phone:408-274-3881
Mailing Address - Fax:408-274-9053
Practice Address - Street 1:1693 FLANIGAN DR
Practice Address - Street 2:#100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121
Practice Address - Country:US
Practice Address - Phone:408-274-3881
Practice Address - Fax:408-274-9053
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2010-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA42236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A422360Medicaid
CA00A422360Medicaid