Healthcare Provider Details

I. General information

NPI: 1679807010
Provider Name (Legal Business Name): MS. DENISE NGOC-UYEN PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S OAK KNOLL AVE
PASADENA CA
91101-2611
US

IV. Provider business mailing address

118 S OAK KNOLL AVE
PASADENA CA
91101-2611
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax: 626-993-3083
Mailing address:
  • Phone: 626-993-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW70132
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: