MEDICARE: DR. ANGELA PHAM BASEN MD

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	208M00000X	Hospitalist Physician	A141493	CA
2	207R00000X	Internal Medicine Physician	A141493	CA

General Provider Information

NPI Number	:	1639514144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA PHAM BASEN MD

Provider Business Mailing Address
First Line	:	24321 AVENIDA DE LA CARLOTA
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3681
Country	:	US
Telephone Number	:	949-204-3006
Fax Number	:

Provider Business Practice Location Address
First Line	:	24321 AVENIDA DE LA CARLOTA
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3681
Country	:	US
Telephone Number	:	949-204-3006
Fax Number	:

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

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	04/24/2024

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