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Individual
KIEUTIEN PHAN TONNU
Active
Individual
KIEUTIEN PHAN TONNU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10429T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0104290
—
CA
01
—
WY158
GROUP MEDICARE #
CA
Enumeration date
06/30/2008
Last updated
09/15/2014
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