Provider Demographics
NPI:1215401583
Name:THAIBINH PHAN MD INC
Entity Type:Organization
Organization Name:THAIBINH PHAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THAIBINH
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-539-4900
Mailing Address - Street 1:10402 WESTMINSTER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4862
Mailing Address - Country:US
Mailing Address - Phone:714-539-4900
Mailing Address - Fax:714-539-4902
Practice Address - Street 1:10402 WESTMINSTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4862
Practice Address - Country:US
Practice Address - Phone:714-539-4900
Practice Address - Fax:714-539-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care