Phornphan Moltane Homiak, PA-C

NPI #1942488374 in Burke, Virginia

Provider Information

NPI Number: 1942488374
Entity Type: Individual
Name: Phornphan Moltane Homiak, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Feb 7, 2008
Last Updated: Nov 18, 2014

Practice Location

Address: 6035 BURKE CENTRE PKWY
Address 2: SUITE 120
City: Burke
State: Virginia
ZIP Code: 22015-3750
Phone: (703) 425-6010

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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