Provider Demographics
NPI:1275169021
Name:CHRISTINE THUY PHAN DMD DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHRISTINE THUY PHAN DMD DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:THUY
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-675-4929
Mailing Address - Street 1:14221 INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6729
Mailing Address - Country:US
Mailing Address - Phone:310-675-4929
Mailing Address - Fax:
Practice Address - Street 1:14221 INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6729
Practice Address - Country:US
Practice Address - Phone:310-675-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty