MEDICARE: KIMBERLY PHAM OD

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	152W00000X	Optometrist	34176TLG	CA

General Provider Information

NPI Number	:	1780157420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY PHAM OD

Provider Business Mailing Address
First Line	:	6332 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1424
Country	:	US
Telephone Number	:	562-421-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	6332 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1424
Country	:	US
Telephone Number	:	562-421-4488
Fax Number	:	562-421-0233

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	01/03/2022

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Directions to “ KIMBERLY PHAM OD” Practice Location

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