Healthcare Provider Details

I. General information

NPI: 1407871015
Provider Name (Legal Business Name): TIMOTHY PHAM D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 LUNDY AVE # 122
SAN JOSE CA
95131-1834
US

IV. Provider business mailing address

1879 LUNDY AVE # 122
SAN JOSE CA
95131-1834
US

V. Phone/Fax

Practice location:
  • Phone: 408-433-3930
  • Fax: 408-433-3931
Mailing address:
  • Phone: 408-433-3930
  • Fax: 408-433-3931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000E39370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: