Healthcare Provider Details

I. General information

NPI: 1952008054
Provider Name (Legal Business Name): VAN THI-KIM PHAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 E 7TH ST
LONG BEACH CA
90804-4619
US

IV. Provider business mailing address

4608 LARWIN AVE
CYPRESS CA
90630-3511
US

V. Phone/Fax

Practice location:
  • Phone: 562-434-0740
  • Fax:
Mailing address:
  • Phone: 612-598-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: