MEDICARE: TUNG PHAN MD INC

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	208D00000X	General Practice Physician	A43113	CA

General Provider Information

NPI Number	:	1518138015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUNG PHAN MD INC

Provider Business Mailing Address
First Line	:	10152 WESTMINSTER AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4754
Country	:	US
Telephone Number	:	714-530-3939
Fax Number	:	714-530-8388

Provider Business Practice Location Address
First Line	:	10152 WESTMINSTER AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4754
Country	:	US
Telephone Number	:	714-530-3939
Fax Number	:	714-530-8388

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MR. TUNG THANH PHAN
Credential	:	MD
Telephone Number	:	714-530-3939

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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