Basic Information
| Provider Information | |||||||||
| NPI: | 1578941126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAN | ||||||||
| FirstName: | XUAN | ||||||||
| MiddleName: | HUY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PHAN | ||||||||
| OtherFirstName: | HUY | ||||||||
| OtherMiddleName: | XUAN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 113 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SILVER CREEK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169344518 | ||||||||
| FaxNumber: | 7169347806 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SILVER CREEK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169344518 | ||||||||
| FaxNumber: | 7169347806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2015 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 295583 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.