MEDICARE: DR. HOA THI NGOC 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
1	207R00000X	Internal Medicine Physician	20A9763	CA

General Provider Information

NPI Number	:	1295919686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOA THI NGOC PHAN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 927534
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92192-7534
Country	:	US
Telephone Number	:	707-980-1178
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 ZONAL AVE
Second Line	:	IRD 620
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0121
Country	:	US
Telephone Number	:	323-226-7556
Fax Number	:

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

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	11/09/2021

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