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NPI Code Detail

MEDICARE: QUENTIN PHAM

MEDICARE: QUENTIN 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
1390200000XStudent in an Organized Health Care Education/Training ProgramSC

General Provider Information

NPI Number : 1528906732
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUENTIN PHAM
Provider Business Mailing Address
First Line : 4320 HOLMESTOWN RD
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-7837
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4320 HOLMESTOWN RD
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-7837
Country : US
Telephone Number : 843-652-8440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ QUENTIN PHAM ” Practice Location

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