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General NPI Number Information
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NPI Number | 1427617505
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Entity Type | Individual
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Provider Name | KATHLEEN CATLAN PHAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 1355 4TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90401-1301
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Country | US
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Telephone | 310-394-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 4TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90401-1301
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Country | US
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Telephone | 818-477-7934
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT-002384
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34398
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License Number State | CA
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