Provider Demographics
NPI:1619068111
Name:PHAM, XUAN HUONG THI (OD)
Entity Type:Individual
Prefix:DR
First Name:XUAN HUONG
Middle Name:THI
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 1:1535 LANDESS AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-8209
Mailing Address - Country:US
Mailing Address - Phone:408-520-4774
Mailing Address - Fax:408-520-4774
Practice Address - Street 1:1535 LANDESS AVE # 117
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-8208
Practice Address - Country:US
Practice Address - Phone:408-520-4774
Practice Address - Fax:408-520-4774
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12955T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA116891Medicare PIN