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General NPI Number Information
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NPI Number | 1891368593
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Entity Type | Individual
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Provider Name | KELLY PHAM OD
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Gender | Female
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 9741 BOLSA AVE STE 115
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City | WESTMINSTER
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State | CA
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Zip | 92683-6683
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Country | US
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Telephone | 714-839-9915
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Fax | 714-839-9974
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Provider Business Mailing Address
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Address Line | 13742 WILSON ST
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City | WESTMINSTER
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State | CA
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Zip | 92683-3336
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Country | US
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Telephone | 714-757-7605
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Fax | 714-839-9974
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34887
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License Number State | CA
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