Provider Demographics
NPI:1912440330
Name:D PHAN MEDICAL CORP
Entity Type:Organization
Organization Name:D PHAN MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-504-9811
Mailing Address - Street 1:8905 GLENOAKS BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-2086
Mailing Address - Country:US
Mailing Address - Phone:818-504-9811
Mailing Address - Fax:818-504-9212
Practice Address - Street 1:8905 GLENOAKS BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-2086
Practice Address - Country:US
Practice Address - Phone:818-504-9811
Practice Address - Fax:818-504-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty