Healthcare Provider Details

I. General information

NPI: 1356899082
Provider Name (Legal Business Name): AN PHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2016
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E BROAD ST
RICHMOND VA
23219-1930
US

IV. Provider business mailing address

9291 KREPP DR
HUNTINGTON BEACH CA
92646-2705
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-5880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60764804
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number144305
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number60764804
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101272792
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: