Provider Demographics
NPI:1497744908
Name:PHAM, HAHN X (MD)
Entity Type:Individual
Prefix:
First Name:HAHN
Middle Name:X
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3229
Mailing Address - Country:US
Mailing Address - Phone:859-276-5344
Mailing Address - Fax:859-223-0490
Practice Address - Street 1:2312 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3229
Practice Address - Country:US
Practice Address - Phone:859-276-5344
Practice Address - Fax:859-223-0490
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64040983Medicaid
KY0576304Medicare ID - Type Unspecified
KY64040983Medicaid