Healthcare Provider Details

I. General information

NPI: 1720615644
Provider Name (Legal Business Name): QUYNH A PHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N MAIN ST
SANTA ANA CA
92701-2304
US

IV. Provider business mailing address

505 S MAIN ST STE 525
ORANGE CA
92868-4553
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 714-456-5631
  • Fax: 714-285-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1720615644
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number183364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: