Healthcare Provider Details

I. General information

NPI: 1891094611
Provider Name (Legal Business Name): TRANG DOAN-MINH PHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W IMPERIAL HWY STE 200
BREA CA
92821-3812
US

IV. Provider business mailing address

955 W IMPERIAL HWY STE 200
BREA CA
92821-3812
US

V. Phone/Fax

Practice location:
  • Phone: 714-626-6310
  • Fax: 714-626-6320
Mailing address:
  • Phone: 714-626-6310
  • Fax: 714-626-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: