Provider Demographics
NPI:1083944417
Name:PHAN, BICH-HANH (MA, SLP-CCC, OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:BICH-HANH
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:MA, SLP-CCC, OTR-L
Other - Prefix:MRS
Other - First Name:HANH
Other - Middle Name:
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, SLP-CCC, OTR-L
Mailing Address - Street 1:3150 ALMADEN EXPY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1200
Mailing Address - Country:US
Mailing Address - Phone:408-332-0259
Mailing Address - Fax:
Practice Address - Street 1:3150 ALMADEN EXPY
Practice Address - Street 2:SUITE 235
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1200
Practice Address - Country:US
Practice Address - Phone:408-332-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3036225XP0200X
CASP11287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics