Healthcare Provider Details

I. General information

NPI: 1497994503
Provider Name (Legal Business Name): KY-VAN PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SOMERSET RD
LEWISVILLE TX
75067-4422
US

IV. Provider business mailing address

1520 SOMERSET RD
LEWISVILLE TX
75067-4422
US

V. Phone/Fax

Practice location:
  • Phone: 214-493-8200
  • Fax:
Mailing address:
  • Phone: 214-493-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number10651
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1696
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: