=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871666768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUONG DO PHAM MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 439 OFARRELL ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-441-4882
-----------------------------------------------------
Fax | 415-441-7389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 559 MARLIN COURT
-----------------------------------------------------
City | REDWOOD CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-591-9242
-----------------------------------------------------
Fax | 415-441-7389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TUONG DO PHAM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 650-591-9242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A35098
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------