Provider Demographics
NPI:1215313408
Name:PHAM, KHOA (DPM)
Entity type:Individual
Prefix:DR
First Name:KHOA
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 S. CONGRESS AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406
Mailing Address - Country:US
Mailing Address - Phone:561-433-5577
Mailing Address - Fax:561-275-2696
Practice Address - Street 1:2326 S CONGRESS AVE STE 1A
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-433-5577
Practice Address - Fax:305-284-7787
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3816213ES0103X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty