Provider Demographics
NPI:1841523230
Name:PHAM, TUAN THANH
Entity type:Individual
Prefix:MR
First Name:TUAN
Middle Name:THANH
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 1:2491 ROSLYN CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-2259
Mailing Address - Country:US
Mailing Address - Phone:408-933-8920
Mailing Address - Fax:
Practice Address - Street 1:393 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1652
Practice Address - Country:US
Practice Address - Phone:408-629-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program