Provider Demographics
NPI:1770544827
Name:DANNY PHU MD INC
Entity type:Organization
Organization Name:DANNY PHU MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:TRIET
Authorized Official - Last Name:PHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-988-2777
Mailing Address - Street 1:701 EAST 28TH ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-988-2777
Mailing Address - Fax:562-988-2779
Practice Address - Street 1:701 EAST 28TH ST
Practice Address - Street 2:SUITE 415
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-988-2777
Practice Address - Fax:562-988-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H77980Medicare UPIN
CAW19301Medicare PIN