Provider Demographics
NPI:1609920016
Name:PHAM, KAREN THU ANH (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN THU
Middle Name:ANH
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 1:1401 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5616
Mailing Address - Country:US
Mailing Address - Phone:408-964-0993
Mailing Address - Fax:
Practice Address - Street 1:1812 GALINDO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2477
Practice Address - Country:US
Practice Address - Phone:925-825-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12639T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEA698AMedicare PIN