Healthcare Provider Details

I. General information

NPI: 1508442104
Provider Name (Legal Business Name): DR. BRANDON HUY PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 414
HIALEAH FL
33013-3835
US

IV. Provider business mailing address

777 E 25TH ST STE 414
HIALEAH FL
33013-3835
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-7588
  • Fax: 305-835-6372
Mailing address:
  • Phone: 305-835-7588
  • Fax: 305-835-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME172927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: