Healthcare Provider Details

I. General information

NPI: 1497331888
Provider Name (Legal Business Name): CYNTHIA PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 E 223RD ST UNIT 28
CARSON CA
90745-4231
US

IV. Provider business mailing address

1223 E 223RD ST UNIT 28
CARSON CA
90745-4231
US

V. Phone/Fax

Practice location:
  • Phone: 310-953-7978
  • Fax:
Mailing address:
  • Phone: 310-953-7978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA201735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: