Provider Demographics
NPI:1497093256
Name:PHAM, KIEUHAN THERESA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIEUHAN
Middle Name:THERESA
Last Name:PHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KIEUHAN
Other - Middle Name:THERESA
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4462
Mailing Address - Country:US
Mailing Address - Phone:405-702-1310
Mailing Address - Fax:405-702-1281
Practice Address - Street 1:3330 NW 56TH ST STE 208
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4426
Practice Address - Country:US
Practice Address - Phone:405-604-0688
Practice Address - Fax:405-604-0689
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPA2216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant