Provider Demographics
NPI:1174396576
Name:PHAM, TONGA LYNN
Entity type:Individual
Prefix:
First Name:TONGA
Middle Name:LYNN
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 GEORGE WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23702-2404
Mailing Address - Country:US
Mailing Address - Phone:757-761-0352
Mailing Address - Fax:
Practice Address - Street 1:4568 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23702-2404
Practice Address - Country:US
Practice Address - Phone:757-761-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier