Healthcare Provider Details

I. General information

NPI: 1184589293
Provider Name (Legal Business Name): MATTHEW QUYTHINH PHAM OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

IV. Provider business mailing address

76 HOWARD ST
BRAINTREE MA
02184-1148
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-5796
  • Fax:
Mailing address:
  • Phone: 617-913-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: