MEDICARE: JENNIFER 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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1326412537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PHAM

Provider Business Mailing Address
First Line	:	3725 COUNTRY CLUB DR UNIT 9
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3725 COUNTRY CLUB DR UNIT 9
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3147
Country	:	US
Telephone Number	:	714-622-9929
Fax Number	:

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

Provider Enumeration Date	:	11/25/2015
Last Update Date	:	11/30/2023

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Directions to “ JENNIFER PHAM ” Practice Location

Language	Start Address	Practice Location

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