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General NPI Number Information
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NPI Number | 1710331962
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Entity Type | Individual
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Provider Name | TRINH THIYEN PHAM MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 310-562-7538
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Fax |
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Provider Business Mailing Address
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Address Line | 808 W VAN BUREN ST UNIT 603
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City | CHICAGO
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State | IL
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Zip | 60607-3839
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Country | US
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Telephone | 310-562-7538
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A178991
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036149532
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License Number State | IL
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