Healthcare Provider Details

I. General information

NPI: 1487000154
Provider Name (Legal Business Name): QUY PHAM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 SW 119TH ST
OKLAHOMA CITY OK
73170-4930
US

IV. Provider business mailing address

1512 SW 119TH ST
OKLAHOMA CITY OK
73170-4930
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-6000
  • Fax: 405-280-1398
Mailing address:
  • Phone: 405-310-6000
  • Fax: 405-280-1398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number32318
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberS4842
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: