Provider Demographics
NPI:1518289503
Name:CAO VAN PHAM M D INC
Entity Type:Organization
Organization Name:CAO VAN PHAM M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT OF CORP.
Authorized Official - Prefix:
Authorized Official - First Name:CAO
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-848-0032
Mailing Address - Street 1:17742 BEACH BLVD
Mailing Address - Street 2:SUITE #230
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6835
Mailing Address - Country:US
Mailing Address - Phone:714-848-0032
Mailing Address - Fax:714-847-4442
Practice Address - Street 1:17742 BEACH BLVD
Practice Address - Street 2:SUITE #230
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6835
Practice Address - Country:US
Practice Address - Phone:714-848-0032
Practice Address - Fax:714-847-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty