Provider Demographics
NPI:1043401698
Name:PHAM, DAVID N (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:N
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14120 BEACH BLVD 101
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4454
Mailing Address - Country:US
Mailing Address - Phone:714-887-0400
Mailing Address - Fax:714-887-0701
Practice Address - Street 1:14120 BEACH BLVD 101
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4454
Practice Address - Country:US
Practice Address - Phone:714-887-0400
Practice Address - Fax:714-887-0701
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86094207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94056Medicare UPIN