Provider Demographics
NPI:1952456121
Name:PHAN, KOY T (101YM0800X)
Entity Type:Individual
Prefix:
First Name:KOY
Middle Name:T
Last Name:PHAN
Suffix:
Gender:F
Credentials:101YM0800X
Other - Prefix:
Other - First Name:KOY
Other - Middle Name:T
Other - Last Name:SAETURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:101YM0800X
Mailing Address - Street 1:3905 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2229
Mailing Address - Country:US
Mailing Address - Phone:510-233-7555
Mailing Address - Fax:510-233-4545
Practice Address - Street 1:3905 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2229
Practice Address - Country:US
Practice Address - Phone:510-233-7555
Practice Address - Fax:510-233-4545
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health