Healthcare Provider Details

I. General information

NPI: 1972765535
Provider Name (Legal Business Name): THO PHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THOMAS PHAM M.D.

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 CALIFORNIA AVE STE 500
BAKERSFIELD CA
93309-7020
US

IV. Provider business mailing address

4550 CALIFORNIA AVE
BAKERSFIELD CA
93309-7012
US

V. Phone/Fax

Practice location:
  • Phone: 661-336-0920
  • Fax: 661-377-0793
Mailing address:
  • Phone: 661-716-7198
  • Fax: 661-377-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA120852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: