Provider Demographics
NPI:1750572434
Name:LA, OANH KIEU (DC)
Entity type:Individual
Prefix:DR
First Name:OANH
Middle Name:KIEU
Last Name:LA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12906 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5809
Mailing Address - Country:US
Mailing Address - Phone:714-638-4852
Mailing Address - Fax:714-638-4127
Practice Address - Street 1:12906 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5809
Practice Address - Country:US
Practice Address - Phone:714-638-4852
Practice Address - Fax:714-638-4127
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor