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General NPI Number Information
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NPI Number | 1902669815
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Entity Type | Organization
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Legal Business Name | TIEN PHAN PSYCHOLOGIST, PC
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 5755 OBERLIN DR STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92121-1786
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Country | US
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Telephone | 858-218-6187
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Fax |
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Provider Business Mailing Address
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Address Line | 5663 BALBOA AVE STE 380
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City | SAN DIEGO
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State | CA
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Zip | 92111-2705
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Country | US
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Telephone | 415-728-5445
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. TIEN VANG PHAN
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Credential | PSYD
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Telephone | 415-728-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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