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General NPI Number Information
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NPI Number | 1114098886
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Entity Type | Organization
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Legal Business Name | NGOC MINH PHAM MD & SUONG MY TUONG MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 2363 ULRIC STREET SUITE B
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City | SAN DIEGO
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State | CA
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Zip | 92111-6447
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Country | US
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Telephone | 858-268-1747
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Fax | 858-268-4172
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Provider Business Mailing Address
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Address Line | 2363 ULRIC ST SUITE B
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City | SAN DIEGO
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State | CA
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Zip | 92111-6447
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Country | US
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Telephone | 858-268-1747
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Fax | 858-268-4172
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Authorized Official
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Title or Position | OWNER
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Name | NGOC MINH PHAM
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Credential | MD
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Telephone | 858-268-1747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A34924
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License Number State | CA
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