Provider Demographics
NPI:1295255735
Name:NGUYEN, PHUNG TP
Entity type:Individual
Prefix:
First Name:PHUNG
Middle Name:TP
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SERRA WAY STE 16
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5245
Mailing Address - Country:US
Mailing Address - Phone:408-836-7200
Mailing Address - Fax:408-649-3068
Practice Address - Street 1:200 SERRA WAY STE 16
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5245
Practice Address - Country:US
Practice Address - Phone:408-836-7200
Practice Address - Fax:408-649-3068
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17482171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist