Provider Demographics
NPI:1578523601
Name:PHAM, KIM-CHI (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM-CHI
Middle Name:
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 1:1975 GLENN MITCHELL DR 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0167
Mailing Address - Country:US
Mailing Address - Phone:757-368-3937
Mailing Address - Fax:
Practice Address - Street 1:1975 GLENN MITCHELL DR 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-368-3937
Practice Address - Fax:757-516-7032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001544152W00000X
FLOPC3939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620769300Medicaid
FL620769300Medicaid