Provider Demographics
NPI:1376942631
Name:PHAM, HONG MY I
Entity Type:Individual
Prefix:
First Name:HONG
Middle Name:MY
Last Name:PHAM
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 W CEDAR PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2114
Mailing Address - Country:US
Mailing Address - Phone:626-689-9997
Mailing Address - Fax:
Practice Address - Street 1:6525 W CEDAR PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2114
Practice Address - Country:US
Practice Address - Phone:626-689-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003858A4AM2A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO003858A4AM2AOtherMEDICAL/RX CARD