Healthcare Provider Details

I. General information

NPI: 1407493323
Provider Name (Legal Business Name): DUONG PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date: 08/29/2025
Reactivation Date: 09/28/2026

III. Provider practice location address

2116 ARLINGTON AVE STE 100
LOS ANGELES CA
90018-1300
US

IV. Provider business mailing address

2116 ARLINGTON AVE STE 100
LOS ANGELES CA
90018-1300
US

V. Phone/Fax

Practice location:
  • Phone: 132-333-4900
  • Fax:
Mailing address:
  • Phone: 132-333-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number141269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: