Healthcare Provider Details

I. General information

NPI: 1376175430
Provider Name (Legal Business Name): PHUOC NGOC PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 THE ALAMEDA
SAN JOSE CA
95126-1136
US

IV. Provider business mailing address

1922 THE ALAMEDA STE 316
SAN JOSE CA
95126-1461
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax: 408-259-2273
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-642-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number697311
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95237355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: