Provider Demographics
NPI:1396503769
Name:PHAM, LAM-PHONG NGUYEN
Entity type:Individual
Prefix:MR
First Name:LAM-PHONG
Middle Name:NGUYEN
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 1:5749 DAINGERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1056
Mailing Address - Country:US
Mailing Address - Phone:571-216-4883
Mailing Address - Fax:
Practice Address - Street 1:5749 DAINGERFIELD WAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1056
Practice Address - Country:US
Practice Address - Phone:571-216-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program