Healthcare Provider Details

I. General information

NPI: 1376506550
Provider Name (Legal Business Name): HIEN THI PHAM M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E JULIAN ST SUITE D
SAN JOSE CA
95112-1809
US

IV. Provider business mailing address

804 E JULIAN ST SUITE D
SAN JOSE CA
95112-1809
US

V. Phone/Fax

Practice location:
  • Phone: 408-288-9826
  • Fax: 408-288-9760
Mailing address:
  • Phone: 408-288-9826
  • Fax: 408-288-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG48282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: