Provider Demographics
NPI:1740938414
Name:VOONG, PHUONG C
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:C
Last Name:VOONG
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 1:3229 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1934
Mailing Address - Country:US
Mailing Address - Phone:215-518-6274
Mailing Address - Fax:
Practice Address - Street 1:3229 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1934
Practice Address - Country:US
Practice Address - Phone:215-454-6016
Practice Address - Fax:215-309-3533
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty