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General NPI Number Information
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NPI Number | 1174981195
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Entity Type | Organization
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Legal Business Name | JASON PHAN DDS INC.
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 23451 MADISON ST STE 210
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City | TORRANCE
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State | CA
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Zip | 90505-4763
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Country | US
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Telephone | 310-378-8342
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Fax | 310-378-4672
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Provider Business Mailing Address
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Address Line | 23451 MADISON ST STE 210
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City | TORRANCE
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State | CA
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Zip | 90505-4763
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Country | US
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Telephone | 310-378-8342
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Fax | 310-378-4672
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON PHAN
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Credential |
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Telephone | 310-378-8342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 58635
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License Number State | CA
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