Healthcare Provider Details

I. General information

NPI: 1083211577
Provider Name (Legal Business Name): KIM PHAN DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE E218
PALM SPRINGS CA
92262-4885
US

IV. Provider business mailing address

PO BOX 2466
PALM SPRINGS CA
92263-2466
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4800
  • Fax: 760-416-4903
Mailing address:
  • Phone: 760-416-4800
  • Fax: 760-416-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM M PHAN
Title or Position: OWNER
Credential: DO
Phone: 502-418-4451