Provider Demographics
NPI:1588680979
Name:PHONG, LAN PAO
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:PAO
Last Name:PHONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 WESTMINSTER AVE STE K
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-1166
Mailing Address - Country:US
Mailing Address - Phone:714-636-6816
Mailing Address - Fax:714-537-4904
Practice Address - Street 1:5110 WESTMINSTER AVE STE K
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-1166
Practice Address - Country:US
Practice Address - Phone:714-636-6816
Practice Address - Fax:714-537-4904
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1550171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist