Individual
THANH PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
217 W BROADWAY APT F31, COLUMBIA, MO 65203-3816
(314) 498-4034
Mailing address
217 W BROADWAY APT F31, COLUMBIA, MO 65203-3816
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/20/2024
Last updated
12/20/2024
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