MEDICARE: DR. OANH T.C PHAN D.D.S

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	41519	CA

General Provider Information

NPI Number	:	1972616621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OANH T.C PHAN D.D.S

Provider Business Mailing Address
First Line	:	40383 LINARIA CIR
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-2488
Country	:	US
Telephone Number	:	510-656-6616
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 E 12TH ST
Second Line	:	SUITE165
City	:	OAKLAND
State	:	CA
Zip	:	94601-3424
Country	:	US
Telephone Number	:	510-533-5500
Fax Number	:	510-485-5109

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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