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NPI Code Detail

MEDICARE: DYLAN PHAM

MEDICARE: DYLAN PHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1134963606
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN PHAM
Provider Business Mailing Address
First Line : 3709 GENOVA LN
Second Line :
City : STOCKTON
State : CA
Zip : 95212-3511
Country : US
Telephone Number : 978-770-9316
Fax Number :
Provider Business Practice Location Address
First Line : 2828 FORD ST
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2114
Country : US
Telephone Number : 510-268-3770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2024
Last Update Date : 06/23/2026

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Directions to “ DYLAN PHAM ” Practice Location

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