Provider Demographics
NPI:1932666815
Name:PHAM, EMI (PA)
Entity Type:Individual
Prefix:
First Name:EMI
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 FORMELLO
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1843
Mailing Address - Country:US
Mailing Address - Phone:714-487-4073
Mailing Address - Fax:
Practice Address - Street 1:2251 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2601
Practice Address - Country:US
Practice Address - Phone:714-449-6230
Practice Address - Fax:714-449-1773
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57134363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical