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General NPI Number Information
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NPI Number | 1881000164
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Entity Type | Individual
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Provider Name | TRUNG PHAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 1150 HARTER PKWY
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City | YUBA CITY
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State | CA
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Zip | 95993-2642
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Country | US
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Telephone | 530-751-0158
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Fax | 530-751-0123
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Provider Business Mailing Address
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Address Line | 3766 LAKE KATIE WAY
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City | SACRAMENTO
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State | CA
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Zip | 95834-7697
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Country | US
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Telephone | 408-505-6370
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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 | 15031
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License Number State | CA
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