Provider Demographics
NPI:1376676247
Name:PHAM, LANA (LICENSE ACUPUNCTURE)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:LICENSE ACUPUNCTURE
Other - Prefix:MRS
Other - First Name:LAN
Other - Middle Name:H
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:628 E SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1902
Mailing Address - Country:US
Mailing Address - Phone:408-275-6000
Mailing Address - Fax:408-279-2825
Practice Address - Street 1:628 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1902
Practice Address - Country:US
Practice Address - Phone:408-275-6000
Practice Address - Fax:408-279-2825
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4487171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0044870Medicaid