MEDICARE: PHIVAN PHAM-CCASA

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
1	363LA2200X	Adult Health Nurse Practitioner	NP95038118	CA

General Provider Information

NPI Number	:	1093674970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHIVAN PHAM-CCASA

Provider Business Mailing Address
First Line	:	9912 CHESHIRE AVE
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4653
Country	:	US
Telephone Number	:	310-873-3312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	04/06/2026

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Directions to “ PHIVAN PHAM-CCASA ” Practice Location

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