MEDICARE: DR. JASON PHAN ND

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	175F00000X	Naturopath	830	CA

General Provider Information

NPI Number	:	1972054666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON PHAN ND

Provider Business Mailing Address
First Line	:	3454 CASTLE GLEN DR
Second Line	:	#226
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2443
Country	:	US
Telephone Number	:	805-368-4183
Fax Number	:

Provider Business Practice Location Address
First Line	:	3454 CASTLE GLEN DR
Second Line	:	#226
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2443
Country	:	US
Telephone Number	:	805-368-4183
Fax Number	:

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

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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