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NPI Code Detail

MEDICARE: JAMIE PHAN MS

MEDICARE: JAMIE PHAN MS
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
1170300000XGenetic Counselor (M.S.)GC001466CA

General Provider Information

NPI Number : 1053089599
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE PHAN MS
Provider Business Mailing Address
First Line : 1804 N LIMA ST
Second Line :
City : BURBANK
State : CA
Zip : 91505-1526
Country : US
Telephone Number : 818-531-8805
Fax Number :
Provider Business Practice Location Address
First Line : 4580 ELECTRONICS PL
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-1008
Country : US
Telephone Number : 818-531-8805
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2021
Last Update Date : 11/16/2021

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