Healthcare Provider Details

I. General information

NPI: 1003493685
Provider Name (Legal Business Name): DAN KIM PHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 11027 ROOM T12.260AC
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE MLC 11027 ROOM T12.260AC
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 954-802-0739
  • Fax:
Mailing address:
  • Phone: 954-802-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME169483
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number35.153002
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: