Healthcare Provider Details

I. General information

NPI: 1831615442
Provider Name (Legal Business Name): THAO THI PHUONG GIANG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 ELK GROVE BLVD
ELK GROVE CA
95758-4186
US

IV. Provider business mailing address

11611 VICILIA ST
GARDEN GROVE CA
92841-1945
US

V. Phone/Fax

Practice location:
  • Phone: 800-972-5547
  • Fax:
Mailing address:
  • Phone: 714-360-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: