Provider Demographics
NPI:1437295425
Name:PHAM, LAN (CASE MANAGER/COORDI)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:CASE MANAGER/COORDI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14140 BEACH BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4453
Mailing Address - Country:US
Mailing Address - Phone:714-896-7570
Mailing Address - Fax:714-896-7564
Practice Address - Street 1:14140 BEACH BLVD STE 155
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4453
Practice Address - Country:US
Practice Address - Phone:714-896-7570
Practice Address - Fax:714-896-7564
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator