Provider Demographics
NPI:1326421827
Name:PHAM, JOHN VINH VAN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VINH VAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 E CAPITOL EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1800
Mailing Address - Country:US
Mailing Address - Phone:408-445-3400
Mailing Address - Fax:408-308-3874
Practice Address - Street 1:1642 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1800
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:408-308-3874
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17004207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine