Healthcare Provider Details

I. General information

NPI: 1790312619
Provider Name (Legal Business Name): BINH PHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009A PALO VERDE AVE
LONG BEACH CA
90815-3322
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD PMB 677206
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 562-239-9980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA196053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: