Provider Demographics
NPI:1235396078
Name:BENJAMIN V PHAM
Entity Type:Organization
Organization Name:BENJAMIN V PHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:650-324-8393
Mailing Address - Street 1:681 OAK GROVE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4333
Mailing Address - Country:US
Mailing Address - Phone:650-324-8393
Mailing Address - Fax:916-408-7297
Practice Address - Street 1:685 TWELVE BRIDGES DR STE F
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8689
Practice Address - Country:US
Practice Address - Phone:916-408-5580
Practice Address - Fax:916-408-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4060332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4724140001Medicare NSC