Individual
DR. ANTHONY THONG PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1189 SWALLOW LN STE 110, SIMI VALLEY, CA 93065-3157
(805) 526-3213
(805) 583-5929
Mailing address
1189 SWALLOW LN STE 110, SIMI VALLEY, CA 93065-3157
(805) 526-3213
(805) 583-5929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G83470
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G834700
MEDICAL PROVIDER NUMBER
CA
01
—
O5D0989497
CLIA
CA
Enumeration date
10/29/2007
Last updated
08/21/2019
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