Healthcare Provider Details

I. General information

NPI: 1649859604
Provider Name (Legal Business Name): JULIE KHANH PHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W MISSION RD STE 305
ALHAMBRA CA
91803-1434
US

IV. Provider business mailing address

2108 N ST STE N
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 909-257-7268
  • Fax: 800-279-1948
Mailing address:
  • Phone: 909-257-7268
  • Fax: 800-279-1948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA183838
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA183838
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number174400000X
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA183838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: