Organization
COASTLINE MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHONG HUNG TRAN M.D. (PRESIDENT)
(714) 531-7730
Entity
Organization
Contact information
Practice address
15606 BROOKHURST ST, SUITE A, WESTMINSTER, CA 92683-7581
(714) 531-7730
(714) 531-7793
Mailing address
PO BOX 9658, FOUNTAIN VALLEY, CA 92728-9658
(714) 531-7730
(714) 531-7793
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
G74233
CA
Other
Enumeration date
11/30/2011
Last updated
06/20/2012
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