Healthcare Provider Details

I. General information

NPI: 1184204067
Provider Name (Legal Business Name): QUEENIE THUY PHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THUY QUYEN LAM PHAM

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E WALNUT AVE
MONROVIA CA
91016-3431
US

IV. Provider business mailing address

13031 HARBOR BLVD # 1052
GARDEN GROVE CA
92843-1739
US

V. Phone/Fax

Practice location:
  • Phone: 818-450-1188
  • Fax: 323-693-1525
Mailing address:
  • Phone: 657-331-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: