Provider Demographics
NPI:1912645102
Name:THE MONG, ANN THUAN (DPT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:THUAN
Last Name:THE MONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9122 PLAYA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-8317
Mailing Address - Country:US
Mailing Address - Phone:714-204-5268
Mailing Address - Fax:
Practice Address - Street 1:16630 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-2716
Practice Address - Country:US
Practice Address - Phone:310-768-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT302047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist