Healthcare Provider Details

I. General information

NPI: 1427924562
Provider Name (Legal Business Name): HUY TAN PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 AUBURN BLVD STE 162
CITRUS HEIGHTS CA
95610-0359
US

IV. Provider business mailing address

8421 AUBURN BLVD STE 162
CITRUS HEIGHTS CA
95610-0359
US

V. Phone/Fax

Practice location:
  • Phone: 916-202-8243
  • Fax: 916-441-6377
Mailing address:
  • Phone: 916-202-8243
  • Fax: 916-441-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-LHKEAF
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: