Provider Demographics
NPI:1922462845
Name:PHAM, MICHAEL DANG (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANG
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-505-1078
Mailing Address - Fax:
Practice Address - Street 1:9616 ARCHIBALD AVE STE 140
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7939
Practice Address - Country:US
Practice Address - Phone:909-481-0436
Practice Address - Fax:909-481-0457
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO034915207W00000X
CA20A19100207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist