Provider Demographics
NPI:1831480060
Name:PHAN, BINH (OTR/L)
Entity Type:Individual
Prefix:
First Name:BINH
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BINH
Other - Middle Name:PHAN
Other - Last Name:DOKULIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:817 S ST ANDREWS PL
Mailing Address - Street 2:APT 308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3357
Mailing Address - Country:US
Mailing Address - Phone:323-683-1863
Mailing Address - Fax:
Practice Address - Street 1:817 S ST ANDREWS PL APT 308
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3370
Practice Address - Country:US
Practice Address - Phone:323-683-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00013691225X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program