Provider Demographics
NPI:1215053442
Name:HO, HIEN PHUOC (DC)
Entity type:Individual
Prefix:
First Name:HIEN
Middle Name:PHUOC
Last Name:HO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9910 MIRA MESA BLVD
Mailing Address - Street 2:SUITE A 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1066
Mailing Address - Country:US
Mailing Address - Phone:858-837-0336
Mailing Address - Fax:858-761-0314
Practice Address - Street 1:9910 MIRA MESA BLVD
Practice Address - Street 2:SUITE A 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1066
Practice Address - Country:US
Practice Address - Phone:858-837-0336
Practice Address - Fax:858-761-0314
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor