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NPI Code Detail

MEDICARE: KHOA V. PHAM M.D.

MEDICARE: KHOA V. PHAM M.D.
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
1207Q00000XFamily Medicine PhysicianK1620TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18U7677OTHERTXBCBS

General Provider Information

NPI Number : 1124056650
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHOA V. PHAM M.D.
Provider Business Mailing Address
First Line : 11908 SHORE POINTE DR
Second Line :
City : PEARLAND
State : TX
Zip : 77584-7199
Country : US
Telephone Number : 832-444-5428
Fax Number : 713-436-6071
Provider Business Practice Location Address
First Line : 1100 W 34TH ST
Second Line :
City : HOUSTON
State : TX
Zip : 77018-6206
Country : US
Telephone Number : 713-867-7880
Fax Number : 713-867-7895
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 05/27/2009

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