Provider Demographics
NPI:1093288813
Name:PHAN, DIEM THUY HONG (RN, MSN)
Entity Type:Individual
Prefix:
First Name:DIEM THUY
Middle Name:HONG
Last Name:PHAN
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16703 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5203
Mailing Address - Country:US
Mailing Address - Phone:562-866-9011
Mailing Address - Fax:562-920-3961
Practice Address - Street 1:16703 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5203
Practice Address - Country:US
Practice Address - Phone:562-866-9011
Practice Address - Fax:562-920-3961
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA632967163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool