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Provider Information for 1720071640



BINH THANH PHAN

Gender: MALE

Individual NPI: 1720071640

Calendar   Last Updated:  2012-01-05
  Certification Date: 

Details

Name Value
NPI 1720071640
Enumeration Date 2005-08-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 6000 N FIGUEROA ST
LOS ANGELES, CA 90042-4232
United States

Phone: 323-254-5291 | Fax: 323-254-4618
View Map External Link
Primary Practice Address 6000 N FIGUEROA ST
LOS ANGELES, CA 90042-4232
United States

Phone: 323-254-5291 | Fax: 323-254-4618
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 53099