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NPI Code Detail

MEDICARE: DR. KHUONG DINH PHAN D.O.

MEDICARE:  DR. KHUONG DINH PHAN  D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianL7520TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00434893OTHERMEDICARE RAILROAD PTAN
3DG4235OTHERMEDICARE RAILROAD GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
28X9320OTHERBCBS PIN
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033119540
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KHUONG DINH PHAN D.O.
Provider Business Mailing Address
First Line : 8200 MATLOCK RD STE 100
Second Line :
City : ARLINGTON
State : TX
Zip : 76002-4805
Country : US
Telephone Number : 817-473-7197
Fax Number : 817-473-7198
Provider Business Practice Location Address
First Line : 8200 MATLOCK RD STE 100
Second Line :
City : ARLINGTON
State : TX
Zip : 76002-4805
Country : US
Telephone Number : 817-473-7197
Fax Number : 817-473-7198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 10/02/2025

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Directions to “ DR. KHUONG DINH PHAN D.O.” Practice Location

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