Provider Demographics
NPI:1538656137
Name:NGUYEN, DAVID VINH-PHUC PHAM (MD)
Entity Type:Individual
Prefix:
First Name:DAVID VINH-PHUC
Middle Name:PHAM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 SUNROAD CENTRUM LN APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1857
Mailing Address - Country:US
Mailing Address - Phone:619-335-0721
Mailing Address - Fax:
Practice Address - Street 1:6911 CONVOY CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1014
Practice Address - Country:US
Practice Address - Phone:858-899-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA174107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine