Healthcare Provider Details

I. General information

NPI: 1427993344
Provider Name (Legal Business Name): LEANNE PHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD STE 304
GARDEN GROVE CA
92843-1917
US

IV. Provider business mailing address

12665 GARDEN GROVE BLVD STE 304
GARDEN GROVE CA
92843-1917
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-5302
  • Fax: 714-537-0592
Mailing address:
  • Phone: 657-263-5124
  • Fax: 714-537-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: