Healthcare Provider Details

I. General information

NPI: 1770535841
Provider Name (Legal Business Name): D Q PHAM MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14160 BROOKHURST ST
GARDEN GROVE CA
92843-4657
US

IV. Provider business mailing address

14160 BROOKHURST ST
GARDEN GROVE CA
92843-4657
US

V. Phone/Fax

Practice location:
  • Phone: 714-534-6911
  • Fax: 714-534-0852
Mailing address:
  • Phone: 714-534-6911
  • Fax: 714-534-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA62320
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA37427
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA37427
License Number StateCA

VIII. Authorized Official

Name: MR. DIEU QUY PHAM
Title or Position: PRESIDENT OF DQ PHAM MEDICAL CORPOR
Credential: MD
Phone: 714-534-6911