Healthcare Provider Details

I. General information

NPI: 1245468081
Provider Name (Legal Business Name): THUYLINH NGOC PHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20300 E VALLEY VIEW PKWY
INDEPENDENCE MO
64057-1672
US

IV. Provider business mailing address

2401 GILLHAM RD PROVIDER ENROLLMENT DEPARTMENT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-5200
  • Fax: 816-302-9939
Mailing address:
  • Phone: 816-234-3000
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-07216
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2011000566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: