MEDICARE: DR. HUAN PHAM M.D.

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	2471C3402X	Radiography Radiologic Technologist	A89509	CA

General Provider Information

NPI Number	:	1770560138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUAN PHAM M.D.

Provider Business Mailing Address
First Line	:	2718 U ST
Second Line	:	#1
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-1965
Country	:	US
Telephone Number	:	408-227-9980
Fax Number	:	916-734-6548

Provider Business Practice Location Address
First Line	:	4860 Y ST
Second Line	:	#3100
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2307
Country	:	US
Telephone Number	:	916-734-5195
Fax Number	:	916-734-6548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	12/22/2021

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