Provider Demographics
NPI:1740716687
Name:PHAN, THOMAS NGOC (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NGOC
Last Name:PHAN
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:1640 NEWPORT BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-7762
Mailing Address - Country:US
Mailing Address - Phone:925-282-1778
Mailing Address - Fax:415-296-5299
Practice Address - Street 1:1640 NEWPORT BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-7762
Practice Address - Country:US
Practice Address - Phone:925-282-1778
Practice Address - Fax:415-296-5299
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP100609452084P0800X
CAA1702662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry