MEDICARE: QUANG QUOC PHAN M.D.

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	207RG0100X	Gastroenterology Physician	A44365	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	:	1982698957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUANG QUOC PHAN M.D.

Provider Business Mailing Address
First Line	:	12665 GARDEN GROVE BLVD
Second Line	:	SUITE 304
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1901
Country	:	US
Telephone Number	:	714-537-5302
Fax Number	:	714-537-0592

Provider Business Practice Location Address
First Line	:	12665 GARDEN GROVE BLVD
Second Line	:	SUITE 304
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1901
Country	:	US
Telephone Number	:	714-537-5302
Fax Number	:	714-537-0592

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/08/2007

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Directions to “ QUANG QUOC PHAN M.D.” Practice Location

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