Provider Demographics
NPI:1093707085
Name:PHAN, BICHVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BICHVAN
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:BICHVAN
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-929-9211
Mailing Address - Fax:408-929-1065
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-929-9211
Practice Address - Fax:408-929-1065
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2012-12-18
Deactivation Date:2006-04-05
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
CAG061219207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE56434Medicare UPIN