MEDICARE: DR. GIA-HUNG L PHAN DC

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	111N00000X	Chiropractor	29087	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841288842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIA-HUNG L PHAN DC

Provider Business Mailing Address
First Line	:	2470 ALVIN AVE STE 30B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1664
Country	:	US
Telephone Number	:	408-217-9736
Fax Number	:	408-217-9772

Provider Business Practice Location Address
First Line	:	2470 ALVIN AVE STE 30B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1664
Country	:	US
Telephone Number	:	408-217-9736
Fax Number	:	408-217-9772

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/01/2023

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