MEDICARE: CAO VAN PHAM M D INC

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
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1518289503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAO VAN PHAM M D INC

Provider Business Mailing Address
First Line	:	17742 BEACH BLVD
Second Line	:	SUITE #230
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6835
Country	:	US
Telephone Number	:	714-848-0032
Fax Number	:	714-847-4442

Provider Business Practice Location Address
First Line	:	17742 BEACH BLVD
Second Line	:	SUITE #230
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6835
Country	:	US
Telephone Number	:	714-848-0032
Fax Number	:	714-847-4442

Authorized Official
Title or Position	:	OWNER/PRESIDENT OF CORP.
Name	:	CAO VAN PHAM
Credential	:	M.D.
Telephone Number	:	714-848-0032

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	02/18/2010

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