MEDICARE: LONG BA 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	133V00000X	Registered Dietitian	996869	CA

General Provider Information

NPI Number	:	1356193742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONG BA PHAM

Provider Business Mailing Address
First Line	:	5261 E THE TOLEDO APT 5
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-1858
Country	:	US
Telephone Number	:	408-314-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	5261 E THE TOLEDO APT 5
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-1858
Country	:	US
Telephone Number	:	408-314-1120
Fax Number	:

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

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	04/01/2024

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Directions to “ LONG BA PHAM ” Practice Location

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