Healthcare Provider Details

I. General information

NPI: 1760898092
Provider Name (Legal Business Name): KARIN PHAM D.O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WYOMING BLVD NE 118
ALBUQUERQUE NM
87112-1035
US

IV. Provider business mailing address

1009 IRON AVE SW
ALBUQUERQUE NM
87102-3751
US

V. Phone/Fax

Practice location:
  • Phone: 505-363-1032
  • Fax:
Mailing address:
  • Phone: 505-363-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1080
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: