Provider Demographics
NPI:1992034722
Name:PHAN, VICTORIA THUY-VIET (BS , MT , ASCP , NCA)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:THUY-VIET
Last Name:PHAN
Suffix:
Gender:F
Credentials:BS , MT , ASCP , NCA
Other - Prefix:MISS
Other - First Name:THUY-VIET
Other - Middle Name:HOANG
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 WRENN DR APT A
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5316
Mailing Address - Country:US
Mailing Address - Phone:919-608-4725
Mailing Address - Fax:
Practice Address - Street 1:109 WRENN DR APT A
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5316
Practice Address - Country:US
Practice Address - Phone:919-608-4725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04125692246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04125692OtherASCP