Healthcare Provider Details

I. General information

NPI: 1972683118
Provider Name (Legal Business Name): LINH THI-THANH PHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S MAIN ST
ORANGE CA
92868-3835
US

IV. Provider business mailing address

14871 BRIDGEPORT RD
TUSTIN CA
92780-6218
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8767
  • Fax: 714-509-4551
Mailing address:
  • Phone: 714-734-6808
  • Fax: 714-734-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number000000A80450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: