MEDICARE: ANH PHAN DMD PC

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

General Provider Information

NPI Number	:	1780521914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANH PHAN DMD PC

Provider Business Mailing Address
First Line	:	PO BOX 8068
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-8068
Country	:	US
Telephone Number	:	916-722-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	6458 TUPELO DR STE A
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-1704
Country	:	US
Telephone Number	:	916-722-2273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANH PHAN
Credential	:	DMD
Telephone Number	:	916-722-2273

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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