Provider Demographics
NPI:1124056650
Name:PHAM, KHOA V (MD)
Entity type:Individual
Prefix:
First Name:KHOA
Middle Name:V
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11908 SHORE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7199
Mailing Address - Country:US
Mailing Address - Phone:832-444-5428
Mailing Address - Fax:713-436-6071
Practice Address - Street 1:1100 W 34TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6206
Practice Address - Country:US
Practice Address - Phone:713-867-7880
Practice Address - Fax:713-867-7895
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U7677OtherBCBS
TX8556J3Medicare PIN
TX8U7677OtherBCBS
TX8F0169Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
TXG13745Medicare UPIN