Provider Demographics
NPI:1396610341
Name:PHAN, MARY NHUNG HOAI
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:NHUNG HOAI
Last Name:PHAN
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 1:9801 BELVEDERE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3640
Mailing Address - Country:US
Mailing Address - Phone:561-273-6500
Mailing Address - Fax:
Practice Address - Street 1:9801 BELVEDERE RD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3640
Practice Address - Country:US
Practice Address - Phone:561-273-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9120846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant