Provider Demographics
NPI:1285389460
Name:PHAN, BINH (DOM, LAC)
Entity type:Individual
Prefix:DR
First Name:BINH
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 PARK BLVD N STE 1
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3328
Mailing Address - Country:US
Mailing Address - Phone:727-385-0052
Mailing Address - Fax:
Practice Address - Street 1:5580 PARK BLVD N STE 1
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3328
Practice Address - Country:US
Practice Address - Phone:727-385-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4317171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist