Provider Demographics
NPI:1992957310
Name:TRIEU, SUSAN PHONG (PHD, , LAC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PHONG
Last Name:TRIEU
Suffix:
Gender:F
Credentials:PHD, , LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EAST LINCOLN AVE.
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-275-8346
Mailing Address - Fax:
Practice Address - Street 1:110 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3818
Practice Address - Country:US
Practice Address - Phone:909-275-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist