Provider Demographics
NPI:1255869566
Name:PHAN, HOA THI XUAN (MD)
Entity type:Individual
Prefix:
First Name:HOA
Middle Name:THI XUAN
Last Name:PHAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15355 BROOKHURST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7071
Mailing Address - Country:US
Mailing Address - Phone:801-433-7212
Mailing Address - Fax:
Practice Address - Street 1:200 S WELLS RD STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1378
Practice Address - Country:US
Practice Address - Phone:805-647-6322
Practice Address - Fax:805-647-7164
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA180758207Q00000X
UT11803314-1205208D00000X
CA5791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice