| Doctor Name: | DR. TATUM K PHAN |
| NPI Number: | 1043649411 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 26065 |
| Business Practice Address: | 1 Shields Ave Student Health & Counseling Services - Uc Davis Davis, CA - 956165270 |
| Business Phone Number: | 5307520871 |
| Business Fax Number: | |
| Mailing Address: | 1 Shields Ave, Student Health & Counseling Services - Uc Davis DAVIS |
| State: | CA |
| Postal Code: | 956165270 |
| Phone Number: | 5307520871 |
| Fax Number: | |
| NPI Enumeration Date: | 11/06/2013 |
| NPI Last Update Date: | 11/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 26065 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |