Provider Demographics
NPI:1760898092
Name:PHAM, KARIN (DOM)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 IRON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3751
Mailing Address - Country:US
Mailing Address - Phone:505-363-1032
Mailing Address - Fax:
Practice Address - Street 1:2601 WYOMING BLVD NE
Practice Address - Street 2:118
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1035
Practice Address - Country:US
Practice Address - Phone:505-363-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist