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General NPI Number Information
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NPI Number | 1245327071
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Entity Type | Individual
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Provider Name | KIM NGUYEN PHAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12966 EUCLID ST SUITE 515
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5200
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Country | US
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Telephone | 714-227-9770
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Fax |
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Provider Business Mailing Address
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Address Line | 26345 YOLANDA ST
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City | LAGUNA HILLS
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State | CA
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Zip | 92656-3114
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Country | US
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Telephone | 949-831-1394
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY17605
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License Number State | CA
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