Healthcare Provider Details

I. General information

NPI: 1548231038
Provider Name (Legal Business Name): THUY LE THU PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17617 PIONEER BLVD
ARTESIA CA
90701-4008
US

IV. Provider business mailing address

17617 PIONEER BLVD
ARTESIA CA
90701-4008
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-2020
  • Fax:
Mailing address:
  • Phone: 562-924-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10157T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: