Provider Demographics
NPI:1689633992
Name:PHAN, TUAN DINH (MD)
Entity Type:Individual
Prefix:DR
First Name:TUAN
Middle Name:DINH
Last Name:PHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44469 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3324
Mailing Address - Country:US
Mailing Address - Phone:661-945-9411
Mailing Address - Fax:661-945-8191
Practice Address - Street 1:44469 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3324
Practice Address - Country:US
Practice Address - Phone:661-945-9411
Practice Address - Fax:661-945-8191
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine