Healthcare Provider Details

I. General information

NPI: 1720933179
Provider Name (Legal Business Name): THUY Q. PHAM MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 WARNER AVE
FOUNTAIN VALLEY CA
92708-2529
US

IV. Provider business mailing address

765 THE CITY DR S STE 150
ORANGE CA
92868-6920
US

V. Phone/Fax

Practice location:
  • Phone: 714-595-1737
  • Fax:
Mailing address:
  • Phone: 714-495-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MALLORIE DANG
Title or Position: MANAGER OF OPERATIONS
Credential:
Phone: 714-495-0905