Provider Demographics
NPI:1003054610
Name:PHAM, DOANH (MD)
Entity Type:Individual
Prefix:
First Name:DOANH
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14536 BROOKHURST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5788
Mailing Address - Country:US
Mailing Address - Phone:714-531-2548
Mailing Address - Fax:714-531-2540
Practice Address - Street 1:14536 BROOKHURST ST STE 102
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5788
Practice Address - Country:US
Practice Address - Phone:714-531-2548
Practice Address - Fax:714-531-2540
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41378208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice