Provider Demographics
NPI:1962642892
Name:VAN THUAN PHAT
Entity type:Organization
Organization Name:VAN THUAN PHAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PHD
Authorized Official - Prefix:DR
Authorized Official - First Name:GUOYUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-377-1353
Mailing Address - Street 1:825 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3550
Mailing Address - Country:US
Mailing Address - Phone:562-599-5795
Mailing Address - Fax:562-599-5795
Practice Address - Street 1:825 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3550
Practice Address - Country:US
Practice Address - Phone:562-599-5795
Practice Address - Fax:562-599-5795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USA TULIP INTERNATIONAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11575261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center