Healthcare Provider Details

I. General information

NPI: 1700231370
Provider Name (Legal Business Name): KATIE PHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 WALKER ST STE 170
CYPRESS CA
90630-4759
US

IV. Provider business mailing address

10601 WALKER ST STE 170
CYPRESS CA
90630-4759
US

V. Phone/Fax

Practice location:
  • Phone: 714-699-4555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95003704
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: