| Duke A Phan Md Neurology Inc | |
|
17220 Newhope St Suite 217 Fountain Valley CA 92708-4272 | |
| (714) 546-4367 | |
| (714) 546-4361 |
| Full Name | Duke A Phan Md Neurology Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 17220 Newhope St, Fountain Valley, California |
| Authorized Official Name and Position | Corina Segovia Diaz (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7143341215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Duke A Phan Md Neurology Inc 17220 Newhope St Suite 217 Fountain Valley CA 92708-4272 Ph: (714) 546-4367 | Duke A Phan Md Neurology Inc 17220 Newhope St Suite 217 Fountain Valley CA 92708-4272 Ph: (714) 546-4367 |
| NPI Number | 1982698767 |
|---|---|
| Provider Enumeration Date | 09/07/2005 |
| Last Update Date | 03/07/2023 |
| Certification Date | 02/28/2020 |
| Medicare PECOS PAC ID | 2567561608 |
|---|---|
| Medicare Enrollment ID | O20070629000606 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982698767 | NPI | - | NPPES |
| 00A511930 | Medicaid | CA | |
| 00A511930 | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | A51193 (California) | Primary |
| Provider Name | Duke A Phan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437352630 PECOS PAC ID: 0749389880 Enrollment ID: I20070629000602 |
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