Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | A133228 | CA |
NPI | 1215297767 |
---|---|
Provider Name | Dr. Peter Phung |
First Address | San Diego, CA 92108-6583 |
Second Address | La Jolla, CA 92093-1503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 12/10/2018 |