Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 310904 | NY |
Y | 207Q00000X | Family Doctor | 83030 | GA |
NPI | 1003270562 |
---|---|
Provider Name | Phong Hoang Do |
First Address | East Hampton, NY 11937-2648 |
Second Address | Smyrna, GA 30080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2016 |
Last Update Date | 08/07/2021 |