MEDICARE: DR. NGA VAN PHAM MD

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	207R00000X	Internal Medicine Physician	A069545	CA

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	:	1831118686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGA VAN PHAM MD

Provider Business Mailing Address
First Line	:	1569 LEXANN AVE
Second Line	:	SUITE 112
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1794
Country	:	US
Telephone Number	:	408-532-0105
Fax Number	:	408-532-0106

Provider Business Practice Location Address
First Line	:	1569 LEXANN AVE
Second Line	:	SUITE 112
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1794
Country	:	US
Telephone Number	:	408-532-0105
Fax Number	:	408-532-0106

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	01/07/2010

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