Healthcare Provider Details

I. General information

NPI: 1225872161
Provider Name (Legal Business Name): PHILEINE PHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

IV. Provider business mailing address

14161 SHORELINE DR UNIT B
CHINO HILLS CA
91709-5960
US

V. Phone/Fax

Practice location:
  • Phone: 562-922-7488
  • Fax:
Mailing address:
  • Phone: 909-731-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: