Healthcare Provider Details

I. General information

NPI: 1386802502
Provider Name (Legal Business Name): CALIFORNIA PACIFIC PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5785 CORPORATE AVE.
CYPRESS CA
90630-4726
US

IV. Provider business mailing address

P.O. BOX 6300
CYPRESS CA
90630-0063
US

V. Phone/Fax

Practice location:
  • Phone: 714-947-8600
  • Fax:
Mailing address:
  • Phone: 714-947-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. DIEN V. PHAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-947-8600