Provider Demographics
NPI:1316907223
Name:PHAN, CHRISTINE THUY-ANH (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:THUY-ANH
Last Name:PHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:THUY
Other - Middle Name:ANH
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:14221 INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6729
Mailing Address - Country:US
Mailing Address - Phone:310-675-4929
Mailing Address - Fax:
Practice Address - Street 1:14221 INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6729
Practice Address - Country:US
Practice Address - Phone:310-675-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice