Individual
JUSTIN PHU THAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8700 BEVERLY BLVD, WEST HOLLYWOOD, CA 90048-1804
(310) 423-4566
(310) 423-9958
Mailing address
4140 W 190TH ST, TORRANCE, CA 90504-5513
(310) 967-1780
(866) 991-4287
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
20A18692
CA
207X00000X
Orthopaedic Surgery Physician
PG177348
OR
Other
Enumeration date
06/07/2016
Last updated
08/30/2021
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