Healthcare Provider Details

I. General information

NPI: 1992336531
Provider Name (Legal Business Name): TIEN KHUC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 02/02/2020
Certification Date: 02/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 WILHELMINA RISE STE B
HONOLULU HI
96816-3287
US

IV. Provider business mailing address

15 ELPHINSTONE STREET
DOOLANDELLA QUEENSLAND
4077407
AU

V. Phone/Fax

Practice location:
  • Phone: 808-260-9056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: