Provider Demographics
NPI:1225177223
Name:PHAM, TIENANH (DO)
Entity Type:Individual
Prefix:
First Name:TIENANH
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:MSC 084770
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2719
Mailing Address - Country:US
Mailing Address - Phone:505-272-6225
Mailing Address - Fax:
Practice Address - Street 1:UNM HOSPITAL FAMILY MEDICINE
Practice Address - Street 2:2211 LOMAS BLVD NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM02R2006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine