Most Relevant Information
Provider Data
| NPI Number: | 1003647371 |
| Provider Name: | KELLY PHAN |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/09/2024 |
| Last Updated: | 08/09/2024 |
Provider Practice Location
1412 KEMP BRIDGE LN
CHESAPEAKE
VA
233205224
Practice Location Phone/Fax
| Phone: | 7575151349 |
| Fax: |
Provider Mailing Location
1412 KEMP BRIDGE LN
CHESAPEAKE
VA
233205224
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |