| T Mai Phan Md Inc | |
|
9500 Bolsa Ave Suite P Westminster CA 92683-5943 | |
| (714) 775-4400 | |
| (714) 775-0149 |
| Full Name | T Mai Phan Md Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9500 Bolsa Ave, Westminster, California |
| Authorized Official Name and Position | Tuyet-mai Phan (PRESIDENT) |
| Authorized Official Contact | 7147754400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| T Mai Phan Md Inc 9500 Bolsa Ave Suite P Westminster CA 92683-5943 Ph: (714) 775-4400 | T Mai Phan Md Inc 9500 Bolsa Ave Suite P Westminster CA 92683-5943 Ph: (714) 775-4400 |
| NPI Number | 1275835688 |
|---|---|
| Provider Enumeration Date | 11/18/2010 |
| Last Update Date | 11/18/2010 |
| Medicare PECOS PAC ID | 5193911709 |
|---|---|
| Medicare Enrollment ID | O20101122000908 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275835688 | NPI | - | NPPES |
| 00G576702 | Medicaid | CA | |
| 00G576701 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (California) | Primary |
| Provider Name | Tuyet-mai M Phan |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1710900477 PECOS PAC ID: 2961698576 Enrollment ID: I20101122001000 |
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