Provider Demographics
NPI:1073692489
Name:PHAM, JOSEPHINE DIEM (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:DIEM
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIEM-TRANG
Other - Middle Name:THI
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2307 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4609
Mailing Address - Country:US
Mailing Address - Phone:408-246-7120
Mailing Address - Fax:408-246-8553
Practice Address - Street 1:2307 FOREST AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4609
Practice Address - Country:US
Practice Address - Phone:408-246-7120
Practice Address - Fax:408-246-8553
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A538820Medicare ID - Type Unspecified
CAG65834Medicare UPIN