Healthcare Provider Details

I. General information

NPI: 1548180862
Provider Name (Legal Business Name): HUY DANG PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S 5TH ST
SAN JOSE CA
95112-5636
US

IV. Provider business mailing address

910 TASSASARA DR
MILPITAS CA
95035-4537
US

V. Phone/Fax

Practice location:
  • Phone: 707-732-8105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: