MEDICARE: DR. DAVID COANG PHAN D.C.

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
1	111N00000X	Chiropractor	DC25784	CA

General Provider Information

NPI Number	:	1033187190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID COANG PHAN D.C.

Provider Business Mailing Address
First Line	:	20519 GERNSIDE DR
Second Line	:	WALNUT
City	:	WALNUT
State	:	CA
Zip	:	91789-3740
Country	:	US
Telephone Number	:	909-594-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	18575 GALE AVE
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91748-1340
Country	:	US
Telephone Number	:	626-369-9663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/08/2007

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