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NPI Code Detail

MEDICARE: JOHN QUOC PHAM

MEDICARE: JOHN QUOC 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1497395909
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN QUOC PHAM
Provider Business Mailing Address
First Line : 12072 PEARCE AVE
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92843-1820
Country : US
Telephone Number : 714-251-7776
Fax Number :
Provider Business Practice Location Address
First Line : 17732 BEACH BLVD
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-6809
Country : US
Telephone Number : 714-655-7142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2020
Last Update Date : 01/13/2020

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Directions to “ JOHN QUOC PHAM ” Practice Location

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