=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982138632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOANG M. PHAN MD,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2017
-----------------------------------------------------
Last Update Date | 10/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6565 FANNIN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-426-9171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 473
-----------------------------------------------------
City | ALIEF
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77411-0473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | HOANG PHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 832-798-7326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------