Basic Information
| Provider Information | |||||||||
| NPI: | 1083211577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIM PHAN DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2466 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922632466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604164800 | ||||||||
| FaxNumber: | 7604164903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 N INDIAN CANYON DR STE E218 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922624885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604164800 | ||||||||
| FaxNumber: | 7604164903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | PHAN | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5024184451 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.