Provider Demographics
NPI:1205090560
Name:PHAM-WARD, ANN (LAC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PHAM-WARD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 W DUARTE RD # G-331
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7564
Mailing Address - Country:US
Mailing Address - Phone:626-446-7027
Mailing Address - Fax:262-446-4723
Practice Address - Street 1:671 W NAOMI AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7502
Practice Address - Country:US
Practice Address - Phone:626-446-7027
Practice Address - Fax:626-446-4723
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9957171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist