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General NPI Number Information
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NPI Number | 1578740775
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Entity Type | Organization
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Legal Business Name | KEVIN PHAM, M.D., INC
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 500 S MAIN ST STE 101
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City | ORANGE
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State | CA
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Zip | 92868-4535
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Country | US
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Telephone | 714-836-4204
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Fax | 714-836-1809
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Provider Business Mailing Address
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Address Line | 500 S MAIN ST STE 101
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City | ORANGE
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State | CA
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Zip | 92868-4535
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Country | US
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Telephone | 714-836-4204
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Fax | 714-836-1809
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN PHAM
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Credential | M.D.
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Telephone | 714-836-4204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A67209
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License Number State | CA
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