Provider Demographics
NPI:1326664475
Name:PHAM, KHANH (OD)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:
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 1:26435 KUYKENDAHL RD STE 800
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1855
Mailing Address - Country:US
Mailing Address - Phone:832-554-1100
Mailing Address - Fax:832-639-0015
Practice Address - Street 1:26435 KUYKENDAHL RD STE 800
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1855
Practice Address - Country:US
Practice Address - Phone:832-554-1100
Practice Address - Fax:832-639-0015
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9958T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist