Healthcare Provider Details

I. General information

NPI: 1972299576
Provider Name (Legal Business Name): THY ANH PHAM L.AC., MSTCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA PHAM L.AC., MSTCM

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3689 18TH ST
SAN FRANCISCO CA
94110-1533
US

IV. Provider business mailing address

3689 18TH ST
SAN FRANCISCO CA
94110-1533
US

V. Phone/Fax

Practice location:
  • Phone: 415-886-7068
  • Fax:
Mailing address:
  • Phone: 415-886-7068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: