Provider Demographics
NPI:1871623215
Name:ONG, PHUONG MAI
Entity type:Individual
Prefix:DR
First Name:PHUONG MAI
Middle Name:
Last Name:ONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:
Other - Last Name:ONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:9376 WESTMINSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4772
Mailing Address - Country:US
Mailing Address - Phone:714-895-4255
Mailing Address - Fax:714-898-8294
Practice Address - Street 1:9376 WESTMINSTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4772
Practice Address - Country:US
Practice Address - Phone:714-895-4255
Practice Address - Fax:714-898-8294
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD53933Medicare ID - Type Unspecified