Provider Demographics
NPI:1245466176
Name:BANH, PHONG QUOC
Entity type:Individual
Prefix:MR
First Name:PHONG
Middle Name:QUOC
Last Name:BANH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1128
Mailing Address - Country:US
Mailing Address - Phone:415-750-5125
Mailing Address - Fax:415-386-2048
Practice Address - Street 1:2020 HAYES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1128
Practice Address - Country:US
Practice Address - Phone:415-750-5125
Practice Address - Fax:415-386-2048
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)