Individual
JOHNNY PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10970 POLARIS DR, SAN DIEGO, CA 92126-2459
(858) 775-2261
Mailing address
10970 POLARIS DR, SAN DIEGO, CA 92126-2459
(858) 775-2261
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
4491866
CA
Other
Enumeration date
12/09/2025
Last updated
12/09/2025
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