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

Theodore Thien Phan

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1104546969

Theodore Thien Phan is a Student in an Organized Health Care Education/Training Program in Novato, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

52 Trinity Dr
Novato, CA 94947-5246
Phone: (415) 320-2313
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 61808 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1104546969
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 31, 2022
Last updated in NPPESDecember 5, 2022
Certification dateDecember 5, 2022
Mailing address52 Trinity Dr, Novato, CA 94947-5246

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