Individual
THE TAI PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
11200 CORBIN AVE, SUITE #208, PORTER RANCH, CA 91326-4120
(818) 368-8522
Mailing address
25 CYMBIDIUM CIR, SOUTH SAN FRANCISCO, CA 94080-2266
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
55427
CA
Other
Enumeration date
01/12/2010
Last updated
06/23/2012
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