Provider Demographics
NPI:1497822019
Name:PHAM, HANNAH NGOC HA (OD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NGOC HA
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2337
Mailing Address - Country:US
Mailing Address - Phone:714-839-7534
Mailing Address - Fax:714-839-9635
Practice Address - Street 1:748 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2337
Practice Address - Country:US
Practice Address - Phone:714-839-7534
Practice Address - Fax:714-839-9635
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12411T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0124110Medicaid
U97974Medicare UPIN
CASD0124110Medicaid