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General NPI Number Information
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NPI Number | 1295628675
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Entity Type | Individual
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Provider Name | THANH T PHAM FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 3851 KATELLA AVE STE 301
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3397
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Country | US
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Telephone | 562-799-3888
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Fax |
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Provider Business Mailing Address
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Address Line | 7377 LA PALMA AVE UNIT 6875
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City | BUENA PARK
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State | CA
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Zip | 90622-8163
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95030531
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95134368
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License Number State | CA
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