Provider Demographics
NPI:1891957718
Name:PHAN, THAIBINH TRAN (MD)
Entity type:Individual
Prefix:DR
First Name:THAIBINH
Middle Name:TRAN
Last Name:PHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9906 DANDELION AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2030
Mailing Address - Country:US
Mailing Address - Phone:714-539-4900
Mailing Address - Fax:714-539-4902
Practice Address - Street 1:10691 WESTMINSTER AVE # 100
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4911
Practice Address - Country:US
Practice Address - Phone:714-539-4900
Practice Address - Fax:714-539-4902
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2024-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA115702207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFI207YMedicare UPIN