Provider Demographics
NPI:1033187190
Name:PHAN, DAVID COANG (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:COANG
Last Name:PHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20519 GERNSIDE DR
Mailing Address - Street 2:WALNUT
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3740
Mailing Address - Country:US
Mailing Address - Phone:909-594-7601
Mailing Address - Fax:
Practice Address - Street 1:18575 GALE AVE
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1340
Practice Address - Country:US
Practice Address - Phone:626-369-9663
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor