Provider Demographics
NPI:1720262744
Name:PHUA, CHRISTINE T (DO)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:T
Last Name:PHUA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:TSANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4908 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042
Mailing Address - Country:US
Mailing Address - Phone:323-540-4336
Mailing Address - Fax:415-503-6099
Practice Address - Street 1:4908 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042
Practice Address - Country:US
Practice Address - Phone:323-540-4336
Practice Address - Fax:415-503-6099
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO034232207Q00000X
CA20A11736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine