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General NPI Number Information
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NPI Number | 1316472814
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Entity Type | Organization
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Legal Business Name | XUAN T PHAM OD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/22/2017
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 6176 BOLLINGER RD
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City | SAN JOSE
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State | CA
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Zip | 95129-3000
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Country | US
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Telephone | 408-265-7466
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Fax | 408-996-1419
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Provider Business Mailing Address
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Address Line | 6176 BOLLINGER RD
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City | SAN JOSE
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State | CA
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Zip | 95129-3000
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Country | US
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Telephone | 408-265-7466
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Fax | 408-996-1419
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. XUAN T PHAM
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Credential | OD
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Telephone | 408-265-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11435
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License Number State | CA
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