Provider Demographics
NPI:1194878926
Name:DOAN, PHI (OD)
Entity type:Individual
Prefix:
First Name:PHI
Middle Name:
Last Name:DOAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13916 BROOKHURST ST STE F
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4331
Mailing Address - Country:US
Mailing Address - Phone:714-530-4167
Mailing Address - Fax:714-530-4260
Practice Address - Street 1:13916 BROOKHURST ST STE F
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4331
Practice Address - Country:US
Practice Address - Phone:714-530-4167
Practice Address - Fax:714-530-4260
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11627T152W00000X
CAHA 7650237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFM427AOtherMEDICARE PTAN
CA1194878926Medicaid
CA1194878926Medicaid