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NPI Code Detail

MEDICARE: KRYSTAL H PHAM MD, LTD

MEDICARE: KRYSTAL H PHAM MD, LTD
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
1261QM2500XMedical Specialty Clinic/Center12284NV

General Provider Information

NPI Number : 1831379650
Entity Type Code : Organization
Provider Name (Legal Business Name) : KRYSTAL H PHAM MD, LTD
Provider Business Mailing Address
First Line : 3040 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1944
Country : US
Telephone Number : 702-477-0101
Fax Number : 702-477-0254
Provider Business Practice Location Address
First Line : 3040 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1944
Country : US
Telephone Number : 702-477-0101
Fax Number : 702-477-0254
Authorized Official
Title or Position : PRESIDENT
Name : KRYSTAL HANHTRAN PHAM
Credential : M.D.
Telephone Number : 702-477-0101
Provider Enumeration Date : 11/08/2007
Last Update Date : 11/08/2007

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