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General NPI Number Information
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NPI Number | 1538302351
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Entity Type | Organization
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Legal Business Name | CANCER AND BLOOD SPECIALTY CLINIC
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 3822 KATELLA AVE
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3302
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Country | US
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Telephone | 627-254-3675
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Fax | 562-725-4369
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Provider Business Mailing Address
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Address Line | P O BOX 743752 LOS ANGELES CA 90074-3752
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City | LOS ANGELES
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State | CA
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Zip | 90074-3752
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Country | US
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Telephone | 562-725-4367
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Fax | 562-725-4369
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. VU Q PHAN
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Credential | M.D.
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Telephone | 562-725-4367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A70377
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | A70377
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | A70377
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License Number State | CA
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