Individual
PHONG LOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2100 GARDINER LN, LOUISVILLE, KY 40205-2962
(502) 413-8640
Mailing address
1245 ABBEY LN, MOUNT PLEASANT, MI 48858-9137
(989) 289-7977
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
MI
Other
Enumeration date
07/22/2026
Last updated
07/22/2026
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