# COASTLINE MEDICAL CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013218007
- **Authorized official:** DR. PHONG H TRAN MD (PRESIDENT)
- **Authorized official phone:** (714) 531-7730

## Contact information

- **Practice address:** 15606 BROOKHURST ST, STE A, WESTMINSTER, CA 92683-7581
- **Practice address phone:** (714) 531-7730
- **Practice address fax:** (714) 531-7793
- **Mailing address:** PO BOX 9658, FOUNTAIN VALLEY, CA 92728-9658
- **Mailing address phone:** (714) 531-7730
- **Mailing address fax:** (714) 531-7793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2010
- **Last updated:** 12/29/2014