Provider Demographics
NPI:1740445154
Name:TIEN, PHUONG Q (MD)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:Q
Last Name:TIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14120 BEACH BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4454
Mailing Address - Country:US
Mailing Address - Phone:714-333-3333
Mailing Address - Fax:714-891-3234
Practice Address - Street 1:14120 BEACH BLVD STE 180
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4454
Practice Address - Country:US
Practice Address - Phone:714-333-3333
Practice Address - Fax:714-891-3234
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1118422081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12373080OtherCAQH