Individual
AMY PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1015 NOGALES ST STE 109A, ROWLAND HEIGHTS, CA 91748-1309
(626) 965-8698
Mailing address
14662 APPALACHIAN ST, CHINO, CA 91710-1358
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT35152-TLG
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/19/2021
Last updated
08/25/2022
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