MAI TUYET PHAN MEDICAL CLINIC A PROFESSIONAL CORPORATION NPI 1588969026

NPI Information

MAI TUYET PHAN MEDICAL CLINIC A PROFESSIONAL CORPORATION is a health service clinic center in Reseda, CA. MAI TUYET PHAN MEDICAL CLINIC A PROFESSIONAL CORPORATION NPI is 1588969026. The provider is registered as an organization entity type.

The provider's business location address is:

18625 SHERMAN WAY
SUITE 104
RESEDA, CA
ZIP 91335-148
Phone: (818) 342-8171

The provider's authorized official is Mai Tuyet Phan .
The authorized official title is M.d. and has the following contact phone number (818) 342-8171.

The CLIA number assigned to this NPI record is 05D0906648 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/13/2011 and was last updated on 10/7/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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