Provider Demographics
NPI:1972681906
Name:PHAN, THUAN NGOC (DC)
Entity Type:Individual
Prefix:DR
First Name:THUAN
Middle Name:NGOC
Last Name:PHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9746 WESTMINSTER AVE
Mailing Address - Street 2:STE B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2984
Mailing Address - Country:US
Mailing Address - Phone:714-534-3169
Mailing Address - Fax:714-534-3146
Practice Address - Street 1:9746 WESTMINSTER AVE
Practice Address - Street 2:STE B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2984
Practice Address - Country:US
Practice Address - Phone:714-534-3169
Practice Address - Fax:714-534-3146
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0259190OtherBLUE SHIELD
CA5468309OtherCCN NETWORK
CA5468309OtherCCN NETWORK