Healthcare Provider Details

I. General information

NPI: 1477183077
Provider Name (Legal Business Name): DZUNG PHAM, DO MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 NAU AVE
TUSTIN CA
92782-3377
US

IV. Provider business mailing address

2940 NAU AVE
TUSTIN CA
92782-3377
US

V. Phone/Fax

Practice location:
  • Phone: 949-654-8455
  • Fax: 888-805-6665
Mailing address:
  • Phone: 949-560-2145
  • Fax: 888-805-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DZUNG PHAM
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 949-560-2145