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NPI Code Detail

MEDICARE: EVAN PHAM

MEDICARE: EVAN PHAM
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
1225100000XPhysical Therapist292457CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11035770941OTHERCAMEDICARE NPI

General Provider Information

NPI Number : 1851834683
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN PHAM
Provider Business Mailing Address
First Line : 7941 BEACH BLVD STE J
Second Line :
City : BUENA PARK
State : CA
Zip : 90620-1900
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7941 BEACH BLVD STE J
Second Line :
City : BUENA PARK
State : CA
Zip : 90620-1900
Country : US
Telephone Number : 714-736-6855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2016
Last Update Date : 05/15/2019

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Directions to “ EVAN PHAM ” Practice Location

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