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General NPI Number Information
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NPI Number | 1023319746
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Entity Type | Individual
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Provider Name | THAI PHOU
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Gender | Male
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 1840 N HACIENDA BLVD STE 12
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City | LA PUENTE
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State | CA
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Zip | 91744-1143
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Country | US
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Telephone | 916-848-5412
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 N HACIENDA BLVD STE 12
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City | LA PUENTE
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State | CA
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Zip | 91744-1143
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Country | US
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Telephone | 909-226-1100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA21328
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21328
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License Number State | CA
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