| Cong T. Phan M.D., Inc. | |
|
8235 Rochester Ave Ste 110 Rancho Cucamonga CA 91730-0719 | |
| (909) 484-4900 | |
| (909) 781-2949 |
| Full Name | Cong T. Phan M.D., Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 8235 Rochester Ave Ste 110, Rancho Cucamonga, California |
| Authorized Official Name and Position | Cong T. Phan (PRESIDENT) |
| Authorized Official Contact | 9099414777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cong T. Phan M.D., Inc. 9303 Jasmine Ave Fountain Valley CA 92708-1960 Ph: (909) 941-4777 | Cong T. Phan M.D., Inc. 8235 Rochester Ave Ste 110 Rancho Cucamonga CA 91730-0719 Ph: (909) 484-4900 |
| NPI Number | 1114354396 |
|---|---|
| Provider Enumeration Date | 10/02/2013 |
| Last Update Date | 09/25/2024 |
| Certification Date | 09/25/2024 |
| Medicare PECOS PAC ID | 8426031139 |
|---|---|
| Medicare Enrollment ID | O20040611000933 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114354396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (California) | Primary |
| Provider Name | Cong T Phan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386778033 PECOS PAC ID: 1759364466 Enrollment ID: I20040720000815 |
| Provider Name | Amy DO |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982128260 PECOS PAC ID: 5092071969 Enrollment ID: I20171108003239 |
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