Provider Demographics
NPI:1437168788
Name:PHAM, HAI HONG (MD)
Entity Type:Individual
Prefix:
First Name:HAI
Middle Name:HONG
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 BELLAIRE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4913
Mailing Address - Country:US
Mailing Address - Phone:713-270-0770
Mailing Address - Fax:713-270-4984
Practice Address - Street 1:6112 BELLAIRE BLVD STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4913
Practice Address - Country:US
Practice Address - Phone:713-270-0770
Practice Address - Fax:713-270-4984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092646101Medicaid
TXC20481Medicare UPIN
TX092646101Medicaid