Healthcare Provider Details

I. General information

NPI: 1619074309
Provider Name (Legal Business Name): NGAN-THUY D PHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 W 117TH ST STE 300
HAWTHORNE CA
90250
US

IV. Provider business mailing address

2550 W MAIN ST STE 301
ALHAMBRA CA
91801-7003
US

V. Phone/Fax

Practice location:
  • Phone: 310-645-0444
  • Fax:
Mailing address:
  • Phone: 626-457-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG82107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: