MEDICARE: MRS. LINH T PHAN DDS

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	1223G0001X	General Practice Dentistry	49976	CA

General Provider Information

NPI Number	:	1578533576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINH T PHAN DDS

Provider Business Mailing Address
First Line	:	125 OLD GROVE RD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-1216
Country	:	US
Telephone Number	:	760-757-4500
Fax Number	:	760-757-4550

Provider Business Practice Location Address
First Line	:	125 OLD GROVE RD
Second Line	:	SUITE 15
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-1216
Country	:	US
Telephone Number	:	760-757-4500
Fax Number	:	760-757-4550

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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