Provider Demographics
NPI:1174740294
Name:PHAN, VU HONG (DC)
Entity type:Individual
Prefix:
First Name:VU
Middle Name:HONG
Last Name:PHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22551 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4128
Mailing Address - Country:US
Mailing Address - Phone:510-733-2225
Mailing Address - Fax:510-733-2555
Practice Address - Street 1:22551 2ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4128
Practice Address - Country:US
Practice Address - Phone:510-733-2225
Practice Address - Fax:510-733-2555
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0287210Medicare ID - Type Unspecified