Provider Demographics
NPI:1750855300
Name:DAM, PHONG TUAN (NP)
Entity type:Individual
Prefix:MR
First Name:PHONG
Middle Name:TUAN
Last Name:DAM
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1726 LEILANI DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-1064
Mailing Address - Country:US
Mailing Address - Phone:323-509-8817
Mailing Address - Fax:
Practice Address - Street 1:939 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3997
Practice Address - Country:US
Practice Address - Phone:360-417-7000
Practice Address - Fax:360-565-9241
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138415207Q00000X
LA208374363L00000X
WAAP61344041363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine