Provider Demographics
NPI:1962170134
Name:PHAM, HOANG VU KHAC (DPT)
Entity type:Individual
Prefix:
First Name:HOANG VU
Middle Name:KHAC
Last Name:PHAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20231 STAGG ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2514
Mailing Address - Country:US
Mailing Address - Phone:818-274-2320
Mailing Address - Fax:
Practice Address - Street 1:330 N HAYWORTH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-2702
Practice Address - Country:US
Practice Address - Phone:323-852-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy