Individual
PHONG TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7301 N 16TH ST STE 202, PHOENIX, AZ 85020-5265
(602) 753-2345
Mailing address
1721 CASTLEGATE DR, SAN JOSE, CA 95132-1712
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD-001122.
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2021
Last updated
08/06/2024
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