Healthcare Provider Details

I. General information

NPI: 1659958734
Provider Name (Legal Business Name): DAN NGO PHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/14/2024
Certification Date: 04/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 S NATIONAL AVE STE 400
SPRINGFIELD MO
65807-5287
US

IV. Provider business mailing address

3850 S NATIONAL AVE STE 400
SPRINGFIELD MO
65807-5287
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-7290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024012431
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: