Provider Demographics
NPI:1548223712
Name:PHAM, HAI HOANG (MD)
Entity Type:Individual
Prefix:
First Name:HAI
Middle Name:HOANG
Last Name:PHAM
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 1:9600 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5949
Mailing Address - Country:US
Mailing Address - Phone:714-531-8711
Mailing Address - Fax:714-531-2330
Practice Address - Street 1:9600 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5949
Practice Address - Country:US
Practice Address - Phone:714-531-8711
Practice Address - Fax:714-531-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A70164AMedicaid
H47052Medicare UPIN
WA70164AMedicare ID - Type Unspecified