Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Johnny Phan

Individual provider Other Specialist/Technologist · NPI 1114880705

Johnny Phan is an Other Specialist/Technologist in San Diego, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2025

Practice location Address checks out

10970 Polaris Dr
San Diego, CA 92126-2459
Phone: (858) 775-2261
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Other Specialist/Technologist (primary) Taxonomy 246Z00000X · Licence 4491866 (CA)

Record details

NPI number1114880705
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 9, 2025
Last updated in NPPESDecember 9, 2025
Certification dateDecember 9, 2025
Mailing address10970 Polaris Dr, San Diego, CA 92126-2459

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