Healthcare Provider Details

I. General information

NPI: 1750639993
Provider Name (Legal Business Name): JOHN PAUL PHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 N MAIN ST, 2ND FL
MILPITAS CA
95035
US

IV. Provider business mailing address

PO BOX 742502
LOS ANGELES CA
90074-2502
US

V. Phone/Fax

Practice location:
  • Phone: 408-957-8300
  • Fax: 408-946-8442
Mailing address:
  • Phone: 408-885-5000
  • Fax: 408-283-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA123403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: