Provider Demographics
NPI:1215824495
Name:PHAN, KALYN (DMD)
Entity type:Individual
Prefix:DR
First Name:KALYN
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N SAGINAW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1282
Mailing Address - Country:US
Mailing Address - Phone:682-286-9300
Mailing Address - Fax:
Practice Address - Street 1:601 N SAGINAW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1282
Practice Address - Country:US
Practice Address - Phone:682-286-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program