Provider Demographics
NPI:1679728604
Name:PHUONG, VIET (MD)
Entity type:Individual
Prefix:
First Name:VIET
Middle Name:
Last Name:PHUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11609 SPRING CYPRESS RD STE C
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8917
Mailing Address - Country:US
Mailing Address - Phone:281-290-6300
Mailing Address - Fax:281-290-6302
Practice Address - Street 1:11609 SPRING CYPRESS RD STE C
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8917
Practice Address - Country:US
Practice Address - Phone:281-290-6300
Practice Address - Fax:281-290-6302
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00042208600000X
OH57.015102208600000X
TXQ0537208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679728604Medicaid
SCNC1848Medicaid
NCNCD716BMedicare PIN
SCNC1848Medicaid