Provider Demographics
NPI:1013160548
Name:PHO, LANA NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:NGOC
Last Name:PHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THANH LAN
Other - Middle Name:NGOC
Other - Last Name:PHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3208
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3208
Mailing Address - Country:US
Mailing Address - Phone:801-587-6340
Mailing Address - Fax:801-587-6346
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-1102
Practice Address - Country:US
Practice Address - Phone:801-587-6340
Practice Address - Fax:801-587-6346
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51102031205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology