Healthcare Provider Details

I. General information

NPI: 1982593794
Provider Name (Legal Business Name): ELAINE PHU RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2977 REDONDO AVE
LONG BEACH CA
90806-2445
US

IV. Provider business mailing address

2977 REDONDO AVE
LONG BEACH CA
90806-2445
US

V. Phone/Fax

Practice location:
  • Phone: 552-988-3418
  • Fax:
Mailing address:
  • Phone: 562-988-3418
  • Fax: 562-595-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86198989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: