Provider Demographics
NPI:1568120665
Name:PHAM, CHRISTINE KIM (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KIM
Last Name:PHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 BALBOA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5016
Mailing Address - Country:US
Mailing Address - Phone:619-757-3985
Mailing Address - Fax:
Practice Address - Street 1:2363 BALBOA VISTA DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5016
Practice Address - Country:US
Practice Address - Phone:619-757-3985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95263708163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health