Healthcare Provider Details

I. General information

NPI: 1326595992
Provider Name (Legal Business Name): KIM OANH PHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date: 08/11/2025
Reactivation Date: 10/01/2025

III. Provider practice location address

80 ARKAY DR
HAUPPAUGE NY
11788-3705
US

IV. Provider business mailing address

80 ARKAY DR
HAUPPAUGE NY
11788-3705
US

V. Phone/Fax

Practice location:
  • Phone: 833-342-1454
  • Fax:
Mailing address:
  • Phone: 714-818-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW127689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: