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General NPI Number Information
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NPI Number | 1952008054
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Entity Type | Individual
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Provider Name | VAN THI-KIM PHAN DDS
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Gender | Female
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 8324 ELK GROVE FLORIN RD
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City | SACRAMENTO
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State | CA
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Zip | 95829-9546
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Country | US
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Telephone | 916-509-3350
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 LIBERTY PL
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City | WOODBURY
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State | MN
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Zip | 55129-5523
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 108579
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License Number State | CA
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