Provider Demographics
NPI:1982087391
Name:PHAM, JIMMY TAM HUY TAM HUY (DO)
Entity type:Individual
Prefix:
First Name:JIMMY TAM HUY
Middle Name:TAM HUY
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:15990 TUSCOLA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2111
Practice Address - Country:US
Practice Address - Phone:442-284-0080
Practice Address - Fax:760-946-3095
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5315072508207R00000X
MI5101022112207R00000X
CA20A16546207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine