MEDICARE: BINH PHAN, D.D.S, 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	1223G0001X	General Practice Dentistry	53099	CA

General Provider Information

NPI Number	:	1710418827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BINH PHAN, D.D.S, INC.

Provider Business Mailing Address
First Line	:	4971 ORANGE AVE
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-2805
Country	:	US
Telephone Number	:	714-826-4640
Fax Number	:	714-826-4672

Provider Business Practice Location Address
First Line	:	4971 ORANGE AVE
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-2805
Country	:	US
Telephone Number	:	714-826-4640
Fax Number	:	714-826-4672

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. BINH PHAN
Credential	:	DDS
Telephone Number	:	562-841-5062

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	03/22/2017

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