Provider Demographics
NPI:1780603365
Name:PHUNG, LANH MANH (MD)
Entity type:Individual
Prefix:DR
First Name:LANH
Middle Name:MANH
Last Name:PHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10130 WARNER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1619
Mailing Address - Country:US
Mailing Address - Phone:714-766-6503
Mailing Address - Fax:714-766-6505
Practice Address - Street 1:10130 WARNER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1619
Practice Address - Country:US
Practice Address - Phone:714-766-6503
Practice Address - Fax:714-766-6505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48978207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489780Medicaid
CAF73580Medicare UPIN
CA00A489780Medicaid