Provider Demographics
NPI:1285344259
Name:PHAN, CELINE NGUYEN-DOAN
Entity type:Individual
Prefix:
First Name:CELINE
Middle Name:NGUYEN-DOAN
Last Name:PHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 MCKEE RD STE A3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1617
Mailing Address - Country:US
Mailing Address - Phone:408-923-8871
Mailing Address - Fax:
Practice Address - Street 1:2350 MCKEE RD STE A3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1617
Practice Address - Country:US
Practice Address - Phone:408-923-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist