MEDICARE: DR. CHRISTIANNE M. PHU D.D.S.

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	122300000X	Dentist	52885	CA

General Provider Information

NPI Number	:	1548413685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIANNE M. PHU D.D.S.

Provider Business Mailing Address
First Line	:	7451 WARNER AVE
Second Line	:	#E-117
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5494
Country	:	US
Telephone Number	:	714-390-6573
Fax Number	:

Provider Business Practice Location Address
First Line	:	7451 WARNER AVE # E-117
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5494
Country	:	US
Telephone Number	:	714-390-6573
Fax Number	:

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

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/14/2014

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