Provider Demographics
NPI:1235239070
Name:PHAM, DOAN TRINH THUY (DPM)
Entity Type:Individual
Prefix:
First Name:DOAN TRINH
Middle Name:THUY
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 1:1521 BESSIE AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3004
Mailing Address - Country:US
Mailing Address - Phone:209-835-4276
Mailing Address - Fax:209-835-1017
Practice Address - Street 1:1521 BESSIE AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3004
Practice Address - Country:US
Practice Address - Phone:209-835-4276
Practice Address - Fax:209-835-1017
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO661213ES0103X
CAE4712213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery