Provider Demographics
NPI:1932121704
Name:PHAM, DANNY SON I (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:SON
Last Name:PHAM
Suffix:I
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:DR
Other - First Name:SON
Other - Middle Name:NAM
Other - Last Name:PHAM
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:9441 SHADWELL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7213
Mailing Address - Country:US
Mailing Address - Phone:714-608-1778
Mailing Address - Fax:714-965-8812
Practice Address - Street 1:12562 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1907
Practice Address - Country:US
Practice Address - Phone:714-608-1778
Practice Address - Fax:714-965-8812
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0888Medicare UPIN