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NPI Code Detail

MEDICARE: NATHAN AN PHAM

MEDICARE: NATHAN AN PHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1023964954
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN AN PHAM
Provider Business Mailing Address
First Line : 12463 S LOPEZ PL
Second Line :
City : TUSTIN
State : CA
Zip : 92782-1519
Country : US
Telephone Number : 949-923-0916
Fax Number :
Provider Business Practice Location Address
First Line : 5460 E LA PALMA AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-2023
Country : US
Telephone Number : 714-463-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2026
Last Update Date : 03/04/2026

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Directions to “ NATHAN AN PHAM ” Practice Location

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