Provider Demographics
NPI:1952861973
Name:PHAN, TRUNG (MD)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:
Last Name:PHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 OLENTANGY RIVER RD STE 1080
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3984
Mailing Address - Country:US
Mailing Address - Phone:614-268-8164
Mailing Address - Fax:614-268-8406
Practice Address - Street 1:3555 OLENTANGY RIVER RD STE 1080
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3984
Practice Address - Country:US
Practice Address - Phone:614-268-8164
Practice Address - Fax:614-268-8406
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine