MEDICARE: BINH THANH 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
1	1223G0001X	General Practice Dentistry	53099	CA
2	122300000X	Dentist	53099	CA

General Provider Information

NPI Number	:	1720071640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BINH THANH PHAN

Provider Business Mailing Address
First Line	:	7911 WILLOW LN
Second Line	:
City	:	LA PALMA
State	:	CA
Zip	:	90623-1662
Country	:	US
Telephone Number	:	714-797-6798
Fax Number	:	714-826-4672

Provider Business Practice Location Address
First Line	:	4971 ORANGE AVE
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-2805
Country	:	US
Telephone Number	:	714-826-4640
Fax Number	:	714-826-4672

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	09/23/2022

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Directions to “ BINH THANH PHAN ” Practice Location

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