Provider Demographics
NPI:1063826741
Name:PHAM, KATHRYN THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:THANH
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8942 GARDEN GROVE BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-3327
Mailing Address - Country:US
Mailing Address - Phone:714-638-0852
Mailing Address - Fax:
Practice Address - Street 1:8942 GARDEN GROVE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-3327
Practice Address - Country:US
Practice Address - Phone:714-638-0852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist