Provider Demographics
NPI:1063606507
Name:PHAM, CHAU NGOC (LAC)
Entity type:Individual
Prefix:
First Name:CHAU
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:655 S FLOWER ST
Mailing Address - Street 2:368
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2805
Mailing Address - Country:US
Mailing Address - Phone:213-430-9180
Mailing Address - Fax:213-430-9193
Practice Address - Street 1:5301 E. WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:213-430-9180
Practice Address - Fax:213-430-9193
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9262171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist