Healthcare Provider Details

I. General information

NPI: 1922783661
Provider Name (Legal Business Name): LILIAN PHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 W LAS POSITAS BLVD STE 150
PLEASANTON CA
94588-5805
US

IV. Provider business mailing address

5866 PALA MESA DR
SAN JOSE CA
95123-4473
US

V. Phone/Fax

Practice location:
  • Phone: 925-534-6880
  • Fax:
Mailing address:
  • Phone: 408-599-9487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number63137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: