Provider Demographics
NPI:1033539150
Name:PHAN, KEVIN HT (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:HT
Last Name:PHAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1801 ORANGE TREE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4587
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:909-557-1732
Practice Address - Street 1:8805 HAVEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5157
Practice Address - Country:US
Practice Address - Phone:909-912-1750
Practice Address - Fax:909-989-4477
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2021-06-06
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Provider Licenses
StateLicense IDTaxonomies
MI4301501266207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery