Bao Long Phan, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

L4198 Issued in TX

Practice address

330 Municipal Dr
Suite 104
Richardson, TX 75080-3651

Phone

(972) 671-6398

Fax

(972) 235-6419

NPI assigned

Nov 16, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: bphan@direct.uspi.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083787048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MUNICIPAL DR",
            "address_2": "SUITE 104",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803651",
            "telephone_number": "972-671-6398",
            "fax_number": "972-235-6419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MUNICIPAL DR",
            "address_2": "SUITE 104",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803651",
            "telephone_number": "972-671-6398",
            "fax_number": "972-235-6419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "BAO",
        "middle_name": "LONG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "L4198",
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "HI",
            "license": "13456",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A61602",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Pham, PHARMD
• Lauren Hanh Pham
• Phat Pham
• Quan D Pham, D.C.
• Audrey Marietta Phan, MD
• Danielle Phan, D.D.S
• Lanh Phan, PHARMD
• Nghi Bao Phan, MD
• Quynh-Dao Nguyen Phan, PHARM D
• Thu Diem-Nguyen Phan, DC

• Plastic Surgery Physician in Richardson, TX
• Providers in Richardson, TX by specialty
• Plastic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.