MEDICARE: PHUNG KIM 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	363LF0000X	Family Nurse Practitioner	AP141772	TX

General Provider Information

NPI Number	:	1609436138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUNG KIM PHAM

Provider Business Mailing Address
First Line	:	10007 BLISSFULL VALLEY LN
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-1018
Country	:	US
Telephone Number	:	832-766-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	13480 VETERANS MEMORIAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1696
Country	:	US
Telephone Number	:	281-587-1600
Fax Number	:

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

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	06/17/2019

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Directions to “ PHUNG KIM PHAM ” Practice Location

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