Provider Demographics
NPI:1225095631
Name:PHAM, CAO VAN (MD)
Entity Type:Individual
Prefix:
First Name:CAO
Middle Name:VAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17742 BEACH BLVD
Mailing Address - Street 2:SUITE #230
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6835
Mailing Address - Country:US
Mailing Address - Phone:714-848-0032
Mailing Address - Fax:714-847-4442
Practice Address - Street 1:17742 BEACH BLVD
Practice Address - Street 2:SUITE #230
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6835
Practice Address - Country:US
Practice Address - Phone:714-848-0032
Practice Address - Fax:714-847-4442
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG32951207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G329510Medicaid
CA00G329510Medicaid
G32951Medicare ID - Type Unspecified