Healthcare Provider Details

I. General information

NPI: 1154673424
Provider Name (Legal Business Name): KAYLYN BICH HONG PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 KATELLA AVE
LOS ALAMITOS CA
90720-2334
US

IV. Provider business mailing address

7 TECHNOLOGY DR
IRVINE CA
92618-2302
US

V. Phone/Fax

Practice location:
  • Phone: 562-594-6599
  • Fax: 562-598-0220
Mailing address:
  • Phone: 949-923-3200
  • Fax: 949-923-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number67605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: