MEDICARE: T MAI PHAN MD INC

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	261Q00000X	Clinic/Center		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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275835688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T MAI PHAN MD INC

Provider Business Mailing Address
First Line	:	9500 BOLSA AVE
Second Line	:	SUITE P
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5943
Country	:	US
Telephone Number	:	714-775-4400
Fax Number	:	714-775-0149

Provider Business Practice Location Address
First Line	:	9500 BOLSA AVE
Second Line	:	SUITE P
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5943
Country	:	US
Telephone Number	:	714-775-4400
Fax Number	:	714-775-0149

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TUYET-MAI PHAN
Credential	:	M.D.
Telephone Number	:	714-775-4400

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/18/2010

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Directions to “T MAI PHAN MD INC ” Practice Location

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