Provider Demographics
NPI:1417003633
Name:PHAN, CU NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:CU
Middle Name:NGOC
Last Name:PHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 NEWPORT CENTER DR STE 409
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7697
Mailing Address - Country:US
Mailing Address - Phone:949-718-4315
Mailing Address - Fax:949-718-4316
Practice Address - Street 1:400 NEWPORT CENTER DR STE 409
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7697
Practice Address - Country:US
Practice Address - Phone:949-718-4315
Practice Address - Fax:949-718-4316
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG064457208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology