Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 62318 | CA |
Y | 1223D0004X | Dentist Anesthesiologist | 8766 | AZ |
NPI | 1144660358 |
---|---|
Provider Name | Dr. Thanh Hoang Phan |
First Address | Tempe, AZ 85284-1348 |
Second Address | Peoria, AZ 85381-5660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2013 |
Last Update Date | 11/01/2017 |