Provider Demographics
NPI:1235481300
Name:HAI PHAN DDS INC
Entity Type:Organization
Organization Name:HAI PHAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAI
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-270-4211
Mailing Address - Street 1:1569 LEXANN AVE
Mailing Address - Street 2:SUITE #108
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1794
Mailing Address - Country:US
Mailing Address - Phone:408-270-4211
Mailing Address - Fax:408-270-4213
Practice Address - Street 1:1569 LEXANN AVE
Practice Address - Street 2:SUITE #108
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1794
Practice Address - Country:US
Practice Address - Phone:408-270-4211
Practice Address - Fax:408-270-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty