Provider Demographics
NPI:1578902524
Name:PHAM, TUNG THANH (LAC)
Entity Type:Individual
Prefix:MR
First Name:TUNG
Middle Name:THANH
Last Name:PHAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8966 GARVEY AVE STE I
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3324
Mailing Address - Country:US
Mailing Address - Phone:626-519-0575
Mailing Address - Fax:
Practice Address - Street 1:8966 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3324
Practice Address - Country:US
Practice Address - Phone:626-519-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15439171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist