Healthcare Provider Details

I. General information

NPI: 1194353193
Provider Name (Legal Business Name): ANDREW PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 04/29/2023
Certification Date: 04/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

11101 BIXLER CIR
GARDEN GROVE CA
92840-2254
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3501
  • Fax: 310-782-1763
Mailing address:
  • Phone: 562-505-7008
  • Fax: 310-782-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number181709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: