Provider Demographics
NPI:1851355101
Name:PHAM, TRUNG NGOC (MD)
Entity type:Individual
Prefix:DR
First Name:TRUNG
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9500 BOLSA AVE
Mailing Address - Street 2:SUITE #A1
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5943
Mailing Address - Country:US
Mailing Address - Phone:714-775-8855
Mailing Address - Fax:714-775-8843
Practice Address - Street 1:9118 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5533
Practice Address - Country:US
Practice Address - Phone:714-899-3839
Practice Address - Fax:714-899-9579
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A455920Medicaid
CAE63939Medicare ID - Type Unspecified
CA00A455920Medicaid