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General NPI Number Information
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NPI Number | 1245427962
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Entity Type | Organization
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Legal Business Name | NGA VAN PHAM, M.D, INC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 1569 LEXANN AVE SUITE 112
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City | SAN JOSE
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State | CA
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Zip | 95121-1794
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Country | US
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Telephone | 408-532-0105
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Fax | 408-532-0106
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Provider Business Mailing Address
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Address Line | 1569 LEXANN AVE SUITE 112
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City | SAN JOSE
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State | CA
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Zip | 95121-1794
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Country | US
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Telephone | 408-532-0105
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Fax | 408-532-0106
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Authorized Official
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Title or Position | PRESIDENT
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Name | NGA VAN PHAM
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Credential | M.D
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Telephone | 408-532-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A69545
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License Number State | CA
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