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1821040866

NPI Code Detail

MEDICARE: DR. JUSTIN HUNG PHAM M.D.

MEDICARE: DR. JUSTIN HUNG PHAM M.D.

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	2085R0202X	Diagnostic Radiology Physician	P3059	TX
2	2085R0202X	Diagnostic Radiology Physician	MD16575	RI
3	2085R0202X	Diagnostic Radiology Physician	036120081	IL
4	2085R0202X	Diagnostic Radiology Physician	21973	MS
5	2085R0202X	Diagnostic Radiology Physician	A72116	CA
6	2085R0202X	Diagnostic Radiology Physician	MD2007-0239	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A711260	OTHER		BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821040866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN HUNG PHAM M.D.

Provider Business Mailing Address
First Line	:	29624 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1296
Country	:	US
Telephone Number	:	608-756-6278
Fax Number	:

Provider Business Practice Location Address
First Line	:	8201 E RIVERSIDE BLVD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-2300
Country	:	US
Telephone Number	:	815-971-7000
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	01/13/2026

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Directions to “ DR. JUSTIN HUNG PHAM M.D.” Practice Location

Language	Start Address	Practice Location

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