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General NPI Number Information
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NPI Number | 1144840836
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Entity Type | Individual
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Provider Name | JUSTINA PHAM
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Gender | Female
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 70 E LAKE ST STE 630
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City | CHICAGO
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State | IL
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Zip | 60601-5961
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Country | US
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Telephone | 312-298-9577
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Fax |
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Provider Business Mailing Address
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Address Line | 2146 N DAYTON ST APT 304
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City | CHICAGO
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State | IL
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Zip | 60614-4343
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Country | US
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Telephone | 773-969-0452
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198001509
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License Number State | IL
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