Healthcare Provider Details

I. General information

NPI: 1679090591
Provider Name (Legal Business Name): LUYEN PHAM DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81713 US HIGHWAY 111
INDIO CA
92201-0721
US

IV. Provider business mailing address

18133 OLD TRAIL LN
FOUNTAIN VALLEY CA
92708-6859
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-2493
  • Fax: 760-342-2549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4677
License Number StateCA

VIII. Authorized Official

Name: DR. LUYEN PHAM
Title or Position: OWNER
Credential: DPM
Phone: 415-794-9841