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NPI Code Detail

MEDICARE: DR. KEVIN CUONG PHAM OD

MEDICARE: DR. KEVIN CUONG 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
1152W00000XOptometrist3514KMN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831619998
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN CUONG PHAM OD
Provider Business Mailing Address
First Line : 3620 PIERCE ST S
Second Line :
City : FARGO
State : ND
Zip : 58104-7563
Country : US
Telephone Number : 701-799-8063
Fax Number :
Provider Business Practice Location Address
First Line : 445 MINNESOTA ST STE 1500
Second Line :
City : SAINT PAUL
State : MN
Zip : 55101-2269
Country : US
Telephone Number : 773-588-3090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2017
Last Update Date : 12/05/2018

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