Healthcare Provider Details

I. General information

NPI: 1205996048
Provider Name (Legal Business Name): AN T PHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 INTERNATIONAL BLVD STE 102
OAKLAND CA
94606-2993
US

IV. Provider business mailing address

600 INTERNATIONAL BLVD STE 102
OAKLAND CA
94606-2993
US

V. Phone/Fax

Practice location:
  • Phone: 510-208-3540
  • Fax: 510-208-3553
Mailing address:
  • Phone: 510-208-3540
  • Fax: 510-208-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA67904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: