Provider Demographics
NPI:1942497193
Name:PHAM, THOMAS TUAN (DO, CAQSM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:TUAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO, CAQSM
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Mailing Address - Street 1:4444 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4136
Mailing Address - Country:US
Mailing Address - Phone:949-929-9519
Mailing Address - Fax:951-274-3442
Practice Address - Street 1:4444 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4136
Practice Address - Country:US
Practice Address - Phone:949-929-9519
Practice Address - Fax:951-274-3442
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9023207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine