Provider Demographics
NPI:1609629443
Name:PHAM, TEVIN TIN (DC)
Entity Type:Individual
Prefix:DR
First Name:TEVIN
Middle Name:TIN
Last Name:PHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8475 S EASTERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2863
Mailing Address - Country:US
Mailing Address - Phone:702-898-3311
Mailing Address - Fax:702-898-3383
Practice Address - Street 1:8475 S EASTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2863
Practice Address - Country:US
Practice Address - Phone:702-898-3311
Practice Address - Fax:702-898-3383
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor