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General NPI Number Information
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NPI Number | 1780061358
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Entity Type | Individual
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Provider Name | BAO PHAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2015
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 1100 WARD AVE STE 700
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City | HONOLULU
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State | HI
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Zip | 96814
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Country | US
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Telephone | 808-544-2600
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Fax | 808-441-1704
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Provider Business Mailing Address
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Address Line | 1100 WARD AVE STE 700
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City | HONOLULU
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State | HI
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Zip | 96814-1617
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Country | US
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Telephone | 808-544-2600
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Fax | 808-441-1704
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-19779
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License Number State | HI
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