Healthcare Provider Details

I. General information

NPI: 1699380485
Provider Name (Legal Business Name): QUYNH NHU PHAN DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8102 WESTMINSTER BLVD STE B
WESTMINSTER CA
92683-3363
US

IV. Provider business mailing address

8102 WESTMINSTER BLVD STE B
WESTMINSTER CA
92683-3363
US

V. Phone/Fax

Practice location:
  • Phone: 714-897-3100
  • Fax: 714-899-3055
Mailing address:
  • Phone: 714-897-3100
  • Fax: 714-899-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: QUYNH NHU PHAN
Title or Position: DENTIST
Credential: DDS
Phone: 714-623-2107