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NPI Code Detail

MEDICARE: KATHY PHAN

MEDICARE: KATHY PHAN
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
1183500000XPharmacistRPH 61845CA

General Provider Information

NPI Number : 1679955512
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY PHAN
Provider Business Mailing Address
First Line : 7201 YORKTOWN AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2465
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7201 YORKTOWN AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2465
Country : US
Telephone Number : 714-536-3679
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2015
Last Update Date : 06/28/2015

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Directions to “ KATHY PHAN ” Practice Location

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