Provider Demographics
NPI:1407965486
Name:PHAN, YEN BICH (DDS)
Entity Type:Individual
Prefix:MS
First Name:YEN
Middle Name:BICH
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 WALKER ST STE A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3128
Mailing Address - Country:US
Mailing Address - Phone:657-313-5571
Mailing Address - Fax:714-699-1975
Practice Address - Street 1:9100 WALKER ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3128
Practice Address - Country:US
Practice Address - Phone:657-313-5571
Practice Address - Fax:714-699-1975
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41772-01OtherDELTA HF
G92858-01OtherDENTIAL