Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 2007018365 | MO |
NPI | 1811195563 |
---|---|
Provider Name | Peter Minh Phan |
First Address | Aliso Viejo, CA 92656-2118 |
Second Address | Aliso Viejo, CA 92656-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2007 |
Last Update Date | 16/09/2009 |