Healthcare Provider Details

I. General information

NPI: 1639514144
Provider Name (Legal Business Name): ANGELA PHAM BASEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA PHAM M.D.

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24321 AVENIDA DE LA CARLOTA
LAGUNA HILLS CA
92653-3681
US

IV. Provider business mailing address

24321 AVENIDA DE LA CARLOTA
LAGUNA HILLS CA
92653-3681
US

V. Phone/Fax

Practice location:
  • Phone: 949-204-3006
  • Fax:
Mailing address:
  • Phone: 949-204-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA141493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA141493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: