Provider Demographics
NPI:1255464814
Name:PHAM, AMY DOAN (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DOAN
Last Name:PHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMY-TRINH
Other - Middle Name:DOAN
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:500 E CALAVERAS BLVD
Mailing Address - Street 2:104
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7703
Mailing Address - Country:US
Mailing Address - Phone:408-262-6620
Mailing Address - Fax:408-262-6286
Practice Address - Street 1:500 E CALAVERAS BLVD
Practice Address - Street 2:104
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7703
Practice Address - Country:US
Practice Address - Phone:408-262-6620
Practice Address - Fax:408-262-6286
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0257821Medicare ID - Type Unspecified
CAU74353Medicare UPIN