Healthcare Provider Details

I. General information

NPI: 1144648957
Provider Name (Legal Business Name): HANNAH PHAM OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HARBOR BLVD STE C4
SANTA ANA CA
92703-3368
US

IV. Provider business mailing address

100 N HARBOR BLVD STE C4
SANTA ANA CA
92703-3368
US

V. Phone/Fax

Practice location:
  • Phone: 714-554-8554
  • Fax: 714-395-6771
Mailing address:
  • Phone: 714-554-8554
  • Fax: 714-395-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. HANNAH NGOC-HA PHAM
Title or Position: OWNER
Credential: O.D.
Phone: 714-554-8554