Provider Demographics
NPI:1518138015
Name:TUNG PHAN MD INC
Entity Type:Organization
Organization Name:TUNG PHAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TUNG
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-530-3939
Mailing Address - Street 1:10152 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4754
Mailing Address - Country:US
Mailing Address - Phone:714-530-3939
Mailing Address - Fax:714-530-8388
Practice Address - Street 1:10152 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4754
Practice Address - Country:US
Practice Address - Phone:714-530-3939
Practice Address - Fax:714-530-8388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUNG PHAN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43113208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF23137Medicare UPIN
CAA43113AMedicare PIN