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General NPI Number Information
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NPI Number | 1538622873
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Entity Type | Individual
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Provider Name | DANIEL DUONG PHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 791 JONESTOWN RD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1252
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Country | US
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Telephone | 367-164-5513
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Fax | 336-716-9642
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Provider Business Mailing Address
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Address Line | 100 KIMEL FOREST DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6074
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Country | US
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Telephone | 336-713-0947
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 10822
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License Number State | GA
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