Healthcare Provider Details

I. General information

NPI: 1114852415
Provider Name (Legal Business Name): CYNTHIA MY-TIEN PHAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8998 APOLLO WAY
DOWNEY CA
90242-4030
US

IV. Provider business mailing address

1027 WILSHIRE BLVD APT 415
LOS ANGELES CA
90017-3110
US

V. Phone/Fax

Practice location:
  • Phone: 562-441-7212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: