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General NPI Number Information
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NPI Number | 1851355101
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Entity Type | Individual
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Provider Name | TRUNG NGOC PHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 9118 BOLSA AVE
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City | WESTMINSTER
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State | CA
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Zip | 92683-5533
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Country | US
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Telephone | 714-899-3839
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Fax | 714-899-9579
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Provider Business Mailing Address
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Address Line | 9500 BOLSA AVE SUITE #A1
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City | WESTMINSTER
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State | CA
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Zip | 92683-5943
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Country | US
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Telephone | 714-775-8855
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Fax | 714-775-8843
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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 | A45592
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License Number State | CA
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