Healthcare Provider Details

I. General information

NPI: 1649621335
Provider Name (Legal Business Name): XUAN PHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRUDY PHAM M.D.

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 02/02/2021
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 JAMESON CT
CARMICHAEL CA
95608-0820
US

IV. Provider business mailing address

5821 JAMESON CT
CARMICHAEL CA
95608-0820
US

V. Phone/Fax

Practice location:
  • Phone: 916-486-0411
  • Fax: 916-486-0946
Mailing address:
  • Phone: 916-486-0411
  • Fax: 916-486-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301110538
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA170010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: