MEDICARE: NHUNG HONG PHAM PA-C

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	207N00000X	Dermatology Physician	3002	OK
2	363A00000X	Physician Assistant	3022	OK

General Provider Information

NPI Number	:	1760034359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NHUNG HONG PHAM PA-C

Provider Business Mailing Address
First Line	:	926 SW 107TH ST STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5244
Country	:	US
Telephone Number	:	405-735-9788
Fax Number	:	405-735-9882

Provider Business Practice Location Address
First Line	:	926 SW 107TH ST STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5244
Country	:	US
Telephone Number	:	405-735-9788
Fax Number	:	405-735-9882

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

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	11/10/2022

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Directions to “ NHUNG HONG PHAM PA-C” Practice Location

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