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NPI Code Detail

MEDICARE: KALIE PHAM

MEDICARE: KALIE 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
1106E00000XAssistant Behavior Analyst

General Provider Information

NPI Number : 1497407340
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALIE PHAM
Provider Business Mailing Address
First Line : 12021 KLING ST APT 107
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-3977
Country : US
Telephone Number : 424-527-6374
Fax Number :
Provider Business Practice Location Address
First Line : 12626 RIVERSIDE DR STE 409
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-3451
Country : US
Telephone Number : 818-661-6306
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2022
Last Update Date : 01/21/2022

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Directions to “ KALIE PHAM ” Practice Location

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