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General NPI Number Information
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NPI Number | 1023423217
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Entity Type | Individual
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Provider Name | PHONG HA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 616 MASSELIN AVE APT 203
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City | LOS ANGELES
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State | CA
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Zip | 90036-3732
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Country | US
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Telephone | 800-889-4447
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 950223
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City | LOUISVILLE
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State | KY
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Zip | 40295-0223
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Country | US
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Telephone | 800-889-4447
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 56352
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License Number State | KY
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