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General NPI Number Information
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NPI Number | 1144600123
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Entity Type | Individual
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Provider Name | DUY-PHU PHAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4555 HOPYARD RD STE C-19
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City | PLEASANTON
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State | CA
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Zip | 94588
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Country | US
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Telephone | 917-932-3217
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Fax |
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Provider Business Mailing Address
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Address Line | 7550 ST PATRICK WAY APT 558
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City | DUBLIN
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State | CA
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Zip | 94568-4887
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Country | US
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Telephone | 917-932-3217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS101456
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License Number State | CA
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