| Anthony Thong Phan Md Inc | |
|
1189 Swallow Ln Ste 110 Simi Valley CA 93065-3157 | |
| (805) 526-3213 | |
| (805) 583-5929 |
| Full Name | Anthony Thong Phan Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1189 Swallow Ln Ste 110, Simi Valley, California |
| Authorized Official Name and Position | Anthony Thong Phan (PRESIDENT CEO) |
| Authorized Official Contact | 8055263213 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anthony Thong Phan Md Inc 1189 Swallow Ln Ste 110 Simi Valley CA 93065-3157 Ph: (805) 526-3213 | Anthony Thong Phan Md Inc 1189 Swallow Ln Ste 110 Simi Valley CA 93065-3157 Ph: (805) 526-3213 |
| NPI Number | 1730139353 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 08/21/2019 |
| Medicare PECOS PAC ID | 9234155508 |
|---|---|
| Medicare Enrollment ID | O20051017000867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730139353 | NPI | - | NPPES |
| 00G834700 | Other | CA | MEDICAL PROVIDER NUMBER |
| 05D0989497 | Other | CA | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | G83470 (California) | Primary |
| Provider Name | Anthony T Phan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124207006 PECOS PAC ID: 6103842471 Enrollment ID: I20051018000391 |
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