Healthcare Provider Details

I. General information

NPI: 1356417752
Provider Name (Legal Business Name): TAM NGUYEN THI PHAM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900A GARDEN GROVE BLVD STE 122
GARDEN GROVE CA
92843
US

IV. Provider business mailing address

PO BOX 775
GARDEN GROVE CA
92842
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-0342
  • Fax: 714-636-0391
Mailing address:
  • Phone: 714-636-0342
  • Fax: 714-636-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG81625
License Number StateCA

VIII. Authorized Official

Name: TAM NGUYEN THI PHAM
Title or Position: PRESIDENT
Credential:
Phone: 714-636-0342