Provider Demographics
NPI:1609104264
Name:PHAN, EMMA TRUNG TRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:TRUNG TRA
Last Name:PHAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 KUHN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4508
Mailing Address - Country:US
Mailing Address - Phone:619-997-6268
Mailing Address - Fax:
Practice Address - Street 1:821 KUHN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4508
Practice Address - Country:US
Practice Address - Phone:619-997-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical