MEDICARE: DR. AN PHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	173638	AK
2	2084P0800X	Psychiatry Physician	MDR-7300	HI
3	2084P0800X	Psychiatry Physician	A195739	CA

General Provider Information

NPI Number	:	1154857373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AN PHAN M.D.

Provider Business Mailing Address
First Line	:	18225 HALE AVE
Second Line	:
City	:	MORGAN HILL
State	:	CA
Zip	:	95037-3547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4604A ROOSEVELT AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-4520
Country	:	US
Telephone Number	:	916-457-3129
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2017
Last Update Date	:	01/09/2026

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