Phung Kim DO, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3083771-1206 Issued in UT

Practice address

4745 S 3200 W
Salt Lake City, UT 84118-2822

Phone

(801) 964-6214

Fax

(801) 982-9232

NPI assigned

Sep 14, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Phung Karen DO Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902901838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5254 PLANTER PL",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841181561",
            "telephone_number": "801-968-3531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 S 3200 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841182822",
            "telephone_number": "801-964-6214",
            "fax_number": "801-982-9232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "PHUNG",
        "middle_name": "KIM",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "3083771-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHUNG",
            "last_name": "DO",
            "middle_name": "KAREN",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Damien Hayden Dizonno, CMHC
• Andre Djurdjic
• Alexis Diann Dlugas
• Emily DO
• Melissa Alexandra DO
• Steven DO
• John Allen Doane, MD
• Kim Doane
• Lauren Lianne Doane
• Grayson Doar, DPT

• Physician Assistant in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.