1689899601 NPI number — DR. DAN PHAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689899601 NPI number — DR. DAN PHAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PHAN

Provider First Name:

DAN

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1689899601

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/22/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1475 N SCOTTSDALE RD STE 200

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SCOTTSDALE

Provider Business Mailing Address State Name:

AZ

Provider Business Mailing Address Postal Code:

85257-3538

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

615-760-6583

Provider Business Mailing Address Fax Number:

615-234-3774

Provider First Line Business Practice Location Address:

2680 S VAL VISTA DR STE 132

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GILBERT

Provider Business Practice Location Address State Name:

AZ

Provider Business Practice Location Address Postal Code:

85295-2155

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

480-253-5618

Provider Business Practice Location Address Fax Number:

480-507-5677

Provider Enumeration Date:

04/16/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207ZP0102X , with the licence number:  58530 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207ZP0102X , with the licence number: A105477 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0102X , with the licence number: 49316 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: GN065W . This is a "MEDICARE PTAN-GEN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: GN065V . This is a "MEDICARE PTAN-MEM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: DN065U . This is a "MEDICARE PTAN-ROSEVILLE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: DN065Z . This is a "MEDICARE PTAN-DPMG" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 1689899601 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: DN065S . This is a "MEDICARE PTAN-AUBURN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: DN065T . This is a "MEDICARE PTAN-DAVIS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: DN065X . This is a "MEDICARE PTAN-MERCY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: DN065Y . This is a "MEDICARE PTAN-METH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".