Provider Demographics
NPI:1811620545
Name:PHAN, KEVIN BUI
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BUI
Last Name:PHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18611 EASTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1303
Mailing Address - Country:US
Mailing Address - Phone:281-488-0179
Mailing Address - Fax:281-282-9764
Practice Address - Street 1:18611 EASTFIELD DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1303
Practice Address - Country:US
Practice Address - Phone:281-488-0179
Practice Address - Fax:281-282-9764
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310585183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician