Doctor Name: | DR. TUNG THANH PHAN |
NPI Number: | 1699848861 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | A43113 |
Business Practice Address: | 10152 Westminster Ave Garden Grove, CA - 928434754 |
Business Phone Number: | 7145303939 |
Business Fax Number: | 7145308388 |
Mailing Address: | 10152 Westminster Ave, GARDEN GROVE |
State: | CA |
Postal Code: | 928434754 |
Phone Number: | 7145303939 |
Fax Number: | 7145308388 |
NPI Enumeration Date: | 11/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A43113 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |