Provider Demographics
NPI:1972299576
Name:PHAM, THY ANH (LAC, MSTCM)
Entity Type:Individual
Prefix:MRS
First Name:THY
Middle Name:ANH
Last Name:PHAM
Suffix:
Gender:F
Credentials:LAC, MSTCM
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MSTCM
Mailing Address - Street 1:3689 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1533
Mailing Address - Country:US
Mailing Address - Phone:415-886-7068
Mailing Address - Fax:
Practice Address - Street 1:3689 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1533
Practice Address - Country:US
Practice Address - Phone:415-886-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist