Provider Demographics
NPI:1114123114
Name:PHAM, DANIEL HOANG (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HOANG
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOANG
Other - Middle Name:MINH-NGO
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6001 S SOONER RD STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-5601
Mailing Address - Country:US
Mailing Address - Phone:405-605-0077
Mailing Address - Fax:405-605-0194
Practice Address - Street 1:6001 S SOONER RD STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-5601
Practice Address - Country:US
Practice Address - Phone:405-605-0077
Practice Address - Fax:405-605-0194
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116018150207Q00000X
OK26781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine