Provider Demographics
NPI:1619148715
Name:PHAM, CHINH QUOC (MD)
Entity Type:Individual
Prefix:DR
First Name:CHINH
Middle Name:QUOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 TIBURON TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6157
Mailing Address - Country:US
Mailing Address - Phone:832-453-1343
Mailing Address - Fax:
Practice Address - Street 1:7715 TIBURON TRL
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6157
Practice Address - Country:US
Practice Address - Phone:832-453-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1418207P00000X, 207Q00000X
WAMD00049216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine