Healthcare Provider Details

I. General information

NPI: 1497109680
Provider Name (Legal Business Name): VIVIAN PHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 12/20/2021
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3020
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 3020
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA154042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: