Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A77798 | CA |
Y | 208600000X | Surgeon | A77798 | CA |
N | 2086S0102X | Surgical Critical Care | A77798 | CA |
N | 2086S0127X | Trauma Surgeon | A77798 | CA |
NPI | 1194796342 |
---|---|
Provider Name | Ho Phan |
First Address | Sacramento, CA 95817-2201 |
Second Address | Sacramento, CA 95817-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 25/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |