Provider Demographics
NPI:1255661815
Name:PHAM, KRISTINE THUY-LINH (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:THUY-LINH
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 THORNWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4132
Mailing Address - Country:US
Mailing Address - Phone:858-663-4879
Mailing Address - Fax:
Practice Address - Street 1:6471 THORNWOOD ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4132
Practice Address - Country:US
Practice Address - Phone:858-663-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13840 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist