Provider Demographics
NPI:1407329824
Name:PHAM, GIA HOA (MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:GIA HOA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14805 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5855
Mailing Address - Country:US
Mailing Address - Phone:714-548-9807
Mailing Address - Fax:
Practice Address - Street 1:15751 BROOKHURST ST STE 130
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7591
Practice Address - Country:US
Practice Address - Phone:714-548-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist