Healthcare Provider Details

I. General information

NPI: 1558289058
Provider Name (Legal Business Name): MAI LY PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 PUAALA LN APT A
HONOLULU HI
96819-4264
US

IV. Provider business mailing address

2002 PUAALA LN APT A
HONOLULU HI
96819-4264
US

V. Phone/Fax

Practice location:
  • Phone: 808-497-0729
  • Fax:
Mailing address:
  • Phone: 808-497-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: