Healthcare Provider Details

I. General information

NPI: 1982144697
Provider Name (Legal Business Name): JOHN PHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23560 MADISON ST STE 205
TORRANCE CA
90505-4710
US

IV. Provider business mailing address

23560 MADISON ST STE 205
TORRANCE CA
90505-4710
US

V. Phone/Fax

Practice location:
  • Phone: 424-622-5437
  • Fax:
Mailing address:
  • Phone: 424-622-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA146427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: