Healthcare Provider Details

I. General information

NPI: 1518289503
Provider Name (Legal Business Name): CAO VAN PHAM M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17742 BEACH BLVD SUITE #230
HUNTINGTON BEACH CA
92647-6835
US

IV. Provider business mailing address

17742 BEACH BLVD SUITE #230
HUNTINGTON BEACH CA
92647-6835
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-0032
  • Fax: 714-847-4442
Mailing address:
  • Phone: 714-848-0032
  • Fax: 714-847-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CAO VAN PHAM
Title or Position: OWNER/PRESIDENT OF CORP.
Credential: M.D.
Phone: 714-848-0032