Healthcare Provider Details

I. General information

NPI: 1881406759
Provider Name (Legal Business Name): LOUIS DAC PHAM DNAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. KHUE DAC DOAN PHAM

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE STE 2703
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

30 PROSPECT AVE STE 2703
HACKENSACK NJ
07601-1915
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2419
  • Fax:
Mailing address:
  • Phone: 551-996-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ15298900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: