MEDICARE: PHUONG-CHI PHAN M.D.

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	207R00000X	Internal Medicine Physician	G76835	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063478402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG-CHI PHAN M.D.

Provider Business Mailing Address
First Line	:	14571 MAGNOLIA ST
Second Line	:	SUITE 207
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5574
Country	:	US
Telephone Number	:	714-890-9241
Fax Number	:	714-890-9541

Provider Business Practice Location Address
First Line	:	14571 MAGNOLIA ST
Second Line	:	SUITE 207
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5574
Country	:	US
Telephone Number	:	714-890-9241
Fax Number	:	714-890-9541

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	01/29/2016

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