MEDICARE: DR. TUYET-MAI M. 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	207W00000X	Ophthalmology Physician	G57670	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710900477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUYET-MAI M. PHAN M.D.

Provider Business Mailing Address
First Line	:	10681 BOLSA AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-5270
Country	:	US
Telephone Number	:	714-775-4400
Fax Number	:	714-775-0149

Provider Business Practice Location Address
First Line	:	9500 BOLSA AVE
Second Line	:	STE P
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5943
Country	:	US
Telephone Number	:	714-775-4400
Fax Number	:	714-775-0149

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	01/27/2021

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