Healthcare Provider Details

I. General information

NPI: 1366193120
Provider Name (Legal Business Name): ELIZABETH HANG PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 BROOKSHIRE AVE STE 202
DOWNEY CA
90241-4983
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-1201
  • Fax:
Mailing address:
  • Phone: 310-423-3333
  • Fax: 310-423-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015779
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: