Provider Demographics
NPI:1265611685
Name:DANG, PHUONG DENISE (MD)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:DENISE
Last Name:DANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4897 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2916
Mailing Address - Country:US
Mailing Address - Phone:469-800-4950
Mailing Address - Fax:469-800-4959
Practice Address - Street 1:4897 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 100
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2916
Practice Address - Country:US
Practice Address - Phone:469-800-4950
Practice Address - Fax:469-800-4959
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM6093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L2972OtherMEDICARE PTAN