Healthcare Provider Details

I. General information

NPI: 1902187248
Provider Name (Legal Business Name): TU OAI VU PHAM CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 ANGUS LEE DR
LAWRENCEVILLE GA
30045-2764
US

IV. Provider business mailing address

1840 ANGUS LEE DR
LAWRENCEVILLE GA
30045-2764
US

V. Phone/Fax

Practice location:
  • Phone: 404-931-1843
  • Fax:
Mailing address:
  • Phone: 404-931-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: