Healthcare Provider Details

I. General information

NPI: 1003733957
Provider Name (Legal Business Name): KHANG PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E W T HARRIS BLVD STE C15
CHARLOTTE NC
28262-3539
US

IV. Provider business mailing address

8807 BLAKENEY DR
CHARLOTTE NC
28277-4700
US

V. Phone/Fax

Practice location:
  • Phone: 980-888-2468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: