Provider Demographics
NPI:1396876322
Name:PHAN, QUYNH NHU (DDS)
Entity type:Individual
Prefix:DR
First Name:QUYNH
Middle Name:NHU
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 VALLEY TER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0205
Mailing Address - Country:US
Mailing Address - Phone:949-725-6393
Mailing Address - Fax:714-897-6343
Practice Address - Street 1:8102 WESTMINSTER BLVD STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3363
Practice Address - Country:US
Practice Address - Phone:714-897-3100
Practice Address - Fax:714-897-6343
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice