Provider Demographics
NPI:1437922325
Name:GIA-HUNG PHAN DC INC.
Entity Type:Organization
Organization Name:GIA-HUNG PHAN DC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIA-HUNG
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:669-400-9313
Mailing Address - Street 1:2470 ALVIN AVE STE 30B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1664
Mailing Address - Country:US
Mailing Address - Phone:408-217-9736
Mailing Address - Fax:408-217-9736
Practice Address - Street 1:2470 ALVIN AVE STE 30B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1664
Practice Address - Country:US
Practice Address - Phone:408-217-9736
Practice Address - Fax:408-217-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center