Provider Demographics
NPI:1255951893
Name:LANE, PHUONG MY (BS)
Entity type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:MY
Last Name:LANE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:PHUONG
Other - Middle Name:M
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:323 S AVENUE 57 APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5204
Mailing Address - Country:US
Mailing Address - Phone:213-219-7861
Mailing Address - Fax:
Practice Address - Street 1:815 COLORADO BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1744
Practice Address - Country:US
Practice Address - Phone:323-543-2800
Practice Address - Fax:323-978-1263
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner