Healthcare Provider Details

I. General information

NPI: 1124554639
Provider Name (Legal Business Name): THOMAS PHAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 MOTOR AVE
CULVER CITY CA
90232-3449
US

IV. Provider business mailing address

4316 MOTOR AVE
CULVER CITY CA
90232-3449
US

V. Phone/Fax

Practice location:
  • Phone: 510-461-4447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A16896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: