Healthcare Provider Details

I. General information

NPI: 1467692871
Provider Name (Legal Business Name): KIM NGUYEN N PHAM OMD, LA.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 EDINGER AVE
WESTMINSTER CA
92683-7425
US

IV. Provider business mailing address

9431 EDINGER AVE
WESTMINSTER CA
92683-7425
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-8400
  • Fax: 714-839-8230
Mailing address:
  • Phone: 714-839-8400
  • Fax: 714-839-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6249
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAC6249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: