Provider Demographics
NPI:1114213311
Name:PHAM, NHA THANH (DPM)
Entity Type:Individual
Prefix:
First Name:NHA
Middle Name:THANH
Last Name:PHAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WILLOW AVE
Mailing Address - Street 2:ATTN: PODIATRY
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 KNOWLES DR STE 220
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1551
Practice Address - Country:US
Practice Address - Phone:408-379-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5211213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery