Healthcare Provider Details

I. General information

NPI: 1841177185
Provider Name (Legal Business Name): AMANDA PHAM DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19712 MACARTHUR BLVD STE 110
IRVINE CA
92612-2407
US

IV. Provider business mailing address

2913 EL CAMINO REAL # 730
TUSTIN CA
92782-8909
US

V. Phone/Fax

Practice location:
  • Phone: 714-702-5140
  • Fax:
Mailing address:
  • Phone: 714-510-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA PHAM
Title or Position: CEO
Credential: D.O.
Phone: 714-702-5140