Basic Information
| Provider Information | |||||||||
| NPI: | 1689899601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAN | ||||||||
| FirstName: | DAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1475 N SCOTTSDALE RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852573538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157606583 | ||||||||
| FaxNumber: | 6152343774 | ||||||||
| Practice Location | |||||||||
| Address1: | 2680 S VAL VISTA DR STE 132 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852952155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802535618 | ||||||||
| FaxNumber: | 4805075677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | A105477 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 49316 | TN | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 58530 | AZ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | GN065W | 01 | CA | MEDICARE PTAN-GEN | OTHER | DN065Y | 01 | CA | MEDICARE PTAN-METH | OTHER | GN065V | 01 | CA | MEDICARE PTAN-MEM | OTHER | 1689899601 | 05 | CA | MEDICAID | DN065T | 01 | CA | MEDICARE PTAN-DAVIS | OTHER | DN065U | 01 | CA | MEDICARE PTAN-ROSEVILLE | OTHER | DN065X | 01 | CA | MEDICARE PTAN-MERCY | OTHER | DN065S | 01 | CA | MEDICARE PTAN-AUBURN | OTHER | DN065Z | 01 | CA | MEDICARE PTAN-DPMG | OTHER |