| NPI | 1114481496 |
|---|---|
| Former Name | VICKY PHAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5456) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 5456) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2026-01-31 |