Healthcare Provider Details

I. General information

NPI: 1720685597
Provider Name (Legal Business Name): KARINA PHAN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 BURNETT AVE STE O
CONCORD CA
94520-5613
US

IV. Provider business mailing address

2733 RIO SECO DR
BAY POINT CA
94565-7774
US

V. Phone/Fax

Practice location:
  • Phone: 925-222-5185
  • Fax:
Mailing address:
  • Phone: 305-764-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number25748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: