Healthcare Provider Details

I. General information

NPI: 1790551505
Provider Name (Legal Business Name): NATHAN PHAM MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17197 NEWHOPE ST STE A-D
FOUNTAIN VALLEY CA
92708-4228
US

IV. Provider business mailing address

17197 NEWHOPE ST STE A-D
FOUNTAIN VALLEY CA
92708-4228
US

V. Phone/Fax

Practice location:
  • Phone: 714-241-0196
  • Fax:
Mailing address:
  • Phone: 714-241-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: