Provider Demographics
NPI:1194148155
Name:PHAM, THANH THAI-THIEN
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:THAI-THIEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WASHINGTON ST
Mailing Address - Street 2:APT. 708
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3755
Mailing Address - Country:US
Mailing Address - Phone:734-846-9528
Mailing Address - Fax:
Practice Address - Street 1:1537 ALTON ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1712
Practice Address - Country:US
Practice Address - Phone:303-923-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator