MEDICARE: DZUNG ANH PHAM D.O.

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	207Q00000X	Family Medicine Physician	20A6269	CA

General Provider Information

NPI Number	:	1790749653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DZUNG ANH PHAM D.O.

Provider Business Mailing Address
First Line	:	2940 NAU AVE
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-3377
Country	:	US
Telephone Number	:	949-654-8455
Fax Number	:	888-805-6665

Provider Business Practice Location Address
First Line	:	2940 NAU AVE
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-3377
Country	:	US
Telephone Number	:	949-654-8455
Fax Number	:	888-805-6665

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	11/23/2020

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