Provider Demographics
NPI:1215366695
Name:PHAN, DUONG THUY (CMT)
Entity Type:Individual
Prefix:
First Name:DUONG
Middle Name:THUY
Last Name:PHAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:THUY-DUONG
Other - Middle Name:
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:12832 GARDEN GROVE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2014
Mailing Address - Country:US
Mailing Address - Phone:714-467-0293
Mailing Address - Fax:714-467-0298
Practice Address - Street 1:12832 GARDEN GROVE BLVD STE B
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2014
Practice Address - Country:US
Practice Address - Phone:714-467-0293
Practice Address - Fax:714-467-0298
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist