Healthcare Provider Details

I. General information

NPI: 1275908832
Provider Name (Legal Business Name): QUOC TRAN PHAM DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 W LINCOLN AVE STE 100
ANAHEIM CA
92805-2912
US

IV. Provider business mailing address

451 W LINCOLN AVE STE 100
ANAHEIM CA
92805-2912
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-6561
  • Fax:
Mailing address:
  • Phone: 714-699-4219
  • Fax: 251-494-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: