Provider Demographics
NPI:1841288842
Name:PHAN, GIA-HUNG L (DC)
Entity type:Individual
Prefix:DR
First Name:GIA-HUNG
Middle Name:L
Last Name:PHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 ALVIN AVE STE 30B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1664
Mailing Address - Country:US
Mailing Address - Phone:408-217-9736
Mailing Address - Fax:408-217-9772
Practice Address - Street 1:2470 ALVIN AVE STE 30B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1664
Practice Address - Country:US
Practice Address - Phone:408-217-9736
Practice Address - Fax:408-217-9772
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841288842Medicaid