Individual
DEREK Q PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21634 RETREAT PKWY, TEMESCAL VALLEY, CA 92883-6100
(951) 493-6650
Mailing address
10798 JURUPA RD, PO BOX 136, JURUPA VALLEY, CA 91752
(213) 569-1450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD61123756
WA
207RC0000X
Cardiovascular Disease Physician
0447579
KS
207RC0000X
Cardiovascular Disease Physician
Primary
100522
WI
207RC0000X
Cardiovascular Disease Physician
A138554
CA
207RI0011X
Interventional Cardiology Physician
0447579
KS
207RI0011X
Interventional Cardiology Physician
100522
WI
207RI0011X
Interventional Cardiology Physician
A138554
CA
207RI0011X
Interventional Cardiology Physician
MD61123756
WA
Other
Enumeration date
04/09/2014
Last updated
07/31/2023
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