Provider Demographics
NPI:1013262302
Name:BOEHME, LAN PHUONG (DPT)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:PHUONG
Last Name:BOEHME
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAN
Other - Middle Name:PHUONG
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1030 20TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4500
Mailing Address - Country:US
Mailing Address - Phone:714-585-7602
Mailing Address - Fax:
Practice Address - Street 1:23388 MULHOLLAND DR
Practice Address - Street 2:MAIL STOP 22
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2733
Practice Address - Country:US
Practice Address - Phone:818-876-1006
Practice Address - Fax:818-876-0542
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGK681ZMedicare PIN