Provider Demographics
NPI:1710001763
Name:PHAM, KRYSTAL HANH TRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:HANH TRAN
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE STE 219
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4048
Mailing Address - Country:US
Mailing Address - Phone:714-486-1228
Mailing Address - Fax:714-486-3108
Practice Address - Street 1:11160 WARNER AVE STE 219
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4048
Practice Address - Country:US
Practice Address - Phone:714-486-1228
Practice Address - Fax:714-486-3108
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12284OtherMEDICAL LICENSE
NV15803OtherPHARMACY LICENSE
CAA114075OtherMEDICAL LICENSE
NVFP0973835OtherDEA CERTIFICATE