Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 51102031205 | UT |
NPI | 1013160548 |
---|---|
Provider Name | Dr. Lana Ngoc Pho |
First Address | Salt Lake City, UT 84110-3208 |
Second Address | Salt Lake City, UT 84132-1102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 15/09/2021 |