Provider Demographics
NPI:1679733927
Name:DARGON, PHONG THANH (MD)
Entity type:Individual
Prefix:MR
First Name:PHONG
Middle Name:THANH
Last Name:DARGON
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 1:15030 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3811
Mailing Address - Country:US
Mailing Address - Phone:760-951-0065
Mailing Address - Fax:760-951-5382
Practice Address - Street 1:15030 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3811
Practice Address - Country:US
Practice Address - Phone:760-951-0065
Practice Address - Fax:760-951-5382
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236799208600000X
CAA1282122086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery