Provider Demographics
NPI:1154591766
Name:KHANH G PHAM, MD INC
Entity type:Organization
Organization Name:KHANH G PHAM, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:GIA
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-891-7035
Mailing Address - Street 1:9191 BOLSA AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5561
Mailing Address - Country:US
Mailing Address - Phone:714-891-7035
Mailing Address - Fax:714-897-8304
Practice Address - Street 1:9191 BOLSA AVE
Practice Address - Street 2:STE 205
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5561
Practice Address - Country:US
Practice Address - Phone:714-891-7035
Practice Address - Fax:714-897-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A418050Medicaid
CAA88576Medicare UPIN
CAA41805Medicare PIN