Provider Demographics
NPI:1386124154
Name:PHAM, ALEXANDER DANG-QUAN
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DANG-QUAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MONUMENT PL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0726
Mailing Address - Country:US
Mailing Address - Phone:714-725-9243
Mailing Address - Fax:
Practice Address - Street 1:22 MONUMENT PL
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0726
Practice Address - Country:US
Practice Address - Phone:714-725-9243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program