MEDICARE: DR. JULIAN HANA PHAN DMD

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	1223P0221X	Pediatric Dentistry	109807	CA

General Provider Information

NPI Number	:	1487300737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIAN HANA PHAN DMD

Provider Business Mailing Address
First Line	:	8014 DOLCE VOLPE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-8260
Country	:	US
Telephone Number	:	702-755-6912
Fax Number	:

Provider Business Practice Location Address
First Line	:	8014 DOLCE VOLPE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-8260
Country	:	US
Telephone Number	:	702-755-6912
Fax Number	:

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

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	07/12/2024

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