Healthcare Provider Details

I. General information

NPI: 1295628675
Provider Name (Legal Business Name): THANH T PHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 KATELLA AVE STE 301
LOS ALAMITOS CA
90720-3397
US

IV. Provider business mailing address

7377 LA PALMA AVE UNIT 6875
BUENA PARK CA
90622-8163
US

V. Phone/Fax

Practice location:
  • Phone: 562-799-3888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030531
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95134368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: