Provider Demographics
NPI:1376603167
Name:PHAN, MELINDA MY (DC)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:MY
Last Name:PHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W HARDER RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-2130
Mailing Address - Country:US
Mailing Address - Phone:510-887-4348
Mailing Address - Fax:
Practice Address - Street 1:402 W HARDER RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2130
Practice Address - Country:US
Practice Address - Phone:510-887-4348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor