Individual
THAI PHOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1840 N HACIENDA BLVD STE 12, LA PUENTE, CA 91744-1143
(916) 848-5412
Mailing address
1840 N HACIENDA BLVD STE 12, LA PUENTE, CA 91744-1143
(909) 226-1100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA21328
CA
363AS0400X
Surgical Physician Assistant
Primary
PA21328
CA
Other
Enumeration date
11/11/2010
Last updated
01/09/2026
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