Provider Demographics
NPI:1811462187
Name:PHUNG, WA SAI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WA
Middle Name:SAI
Last Name:PHUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 KEITH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3130
Mailing Address - Country:US
Mailing Address - Phone:323-342-3158
Mailing Address - Fax:
Practice Address - Street 1:1800 W EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3403
Practice Address - Country:US
Practice Address - Phone:818-238-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist