Healthcare Provider Details

I. General information

NPI: 1801253471
Provider Name (Legal Business Name): NHIEN PHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

V. Phone/Fax

Practice location:
  • Phone: 618-256-7018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101263067
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: