MEDICARE: MR. HUAN PHU PHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	102X00000X	Poetry Therapist
2	1710I1003X	Independent Duty Medical Technicians
3	171WH0202X	Home Modifications Contractor
4	174400000X	Specialist
5	177F00000X	Lodging Provider
6	251X00000X	Supports Brokerage Agency
7	302F00000X	Exclusive Provider Organization
8	305S00000X	Point of Service
9	331L00000X	Blood Bank
10	342000000X	Transportation Network Company
11	344800000X	Air Carrier
12	347C00000X	Private Vehicle
13	347D00000X	Train
14	347E00000X	Transportation Broker
15	1744R1103X	Research Study Abstracter/Coder

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649995937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HUAN PHU PHAM

Provider Business Mailing Address
First Line	:	5252 EL CAJON BLVD APT 208
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4762
Country	:	US
Telephone Number	:	619-314-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	5252 EL CAJON BLVD APT 208
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4762
Country	:	US
Telephone Number	:	619-314-2728
Fax Number	:

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

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/10/2022

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Directions to “ MR. HUAN PHU PHAM ” Practice Location

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