Organization
DR. JIMMY PHAN MEDICAL CORPORATION
Active
Other names
Lake ELsinore Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIMMY NINH HOANG PHAN M.D. (CEO)
(714) 232-9493
Entity
Organization
Contact information
Practice address
425 DIAMOND DR STE 103, LAKE ELSINORE, CA 92530-4495
(951) 981-3122
Mailing address
425 DIAMOND DR STE 103, LAKE ELSINORE, CA 92530-4495
(951) 981-3122
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
12/15/2021
Last updated
01/27/2022
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