Provider Demographics
NPI:1841600798
Name:PHAM, VIEN D
Entity Type:Individual
Prefix:
First Name:VIEN
Middle Name:D
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14241 E 4TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9084
Mailing Address - Country:US
Mailing Address - Phone:720-216-1147
Mailing Address - Fax:720-216-1571
Practice Address - Street 1:14241 E 4TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9084
Practice Address - Country:US
Practice Address - Phone:720-216-1147
Practice Address - Fax:720-216-1571
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies