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General NPI Number Information
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NPI Number | 1316143944
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Entity Type | Organization
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Legal Business Name | THOI PHU PHAN
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 345 9TH ST STE #206
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City | OAKLAND
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State | CA
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Zip | 94607-6522
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Country | US
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Telephone | 510-465-4817
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Fax |
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Provider Business Mailing Address
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Address Line | 345 9TH ST STE #206
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City | OAKLAND
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State | CA
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Zip | 94607-6522
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Country | US
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Telephone | 510-465-4817
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOI PHU PHAN
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Credential | D.D.S
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Telephone | 408-223-6953
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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 | B32222
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License Number State | CA
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