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General NPI Number Information
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NPI Number | 1336601574
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Entity Type | Individual
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Provider Name | TIFFANY THIENTHAO PHAM MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 11199 SORRENTO VALLEY RD STE 202
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City | SAN DIEGO
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State | CA
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Zip | 92121-1334
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Country | US
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Telephone | 858-282-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 11199 SORRENTO VALLEY RD STE 202
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City | SAN DIEGO
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State | CA
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Zip | 92121-1334
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Country | US
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Telephone | 868-282-0212
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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 | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | A202627
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License Number State | CA
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