Provider Demographics
NPI:1457458630
Name:DAVID N. PHAM, MD, INC
Entity Type:Organization
Organization Name:DAVID N. PHAM, MD, INC
Other - Org Name:COMPREHENSIVE PULMONARY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-887-0400
Mailing Address - Street 1:14120 BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4454
Mailing Address - Country:US
Mailing Address - Phone:714-887-0400
Mailing Address - Fax:714-887-0701
Practice Address - Street 1:14120 BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4454
Practice Address - Country:US
Practice Address - Phone:714-887-0400
Practice Address - Fax:714-887-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86094207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G860940Medicaid
CA00G860940Medicaid
CAW15821Medicare ID - Type UnspecifiedGROUP PROVIDER ID